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HEICSHEICSHHEE I ICCSS

The Hospital EmergencyThe Hospital EmergencyIncident Command SystemIncident Command System

Third EditionJune, 1998

Volume I

A Project ofSan Mateo County Department of Health Services

Emergency Medical Services Agencywith grant support from

California Emergency Medical Services Authority

H E I C S

THE

HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM

San Mateo County Health Services AgencyEmergency Medical Services

Third Edition

Volume I

June, 1998

THE THIRD EDITION

of the

HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM

developed by:

The San Mateo County Health Services Agency, Emergency Medical Services

Margaret Taylor, DirectorBarbara Pletz, R.N., EMS Program Administrator

Donald Cheu, M.D., EMS Medical DirectorPaul Russell, R.N., HEICS Update Project Coordinator

Ellen Nave, B.S., EMS Program Specialist

with funding provided by:

State of California Emergency Medical Services Authorityunder Prevention 2000 Block Grant

Grant Contract #EMS-6040

Richard Watson, Interim DirectorDaniel R. Smiley, Deputy Director

Jeffery Rubin, Chief, Disaster Services

June, 1998San Mateo, California

All material contained in this manuscript is the joint property of the State of California Emergency Medical Services Authority and theCounty of San Mateo Health Services Agency - Emergency Medical Services Agency. Publication rights to any material contained

herein are reserved to the State of California Emergency Medical Services Authority

i

Table of Contents

Hospital Emergency Incident Command System – Volume I

Table of Contents .....................................................................................i

HEICS Revision Task Force and Support ...............................................ii

Forward to Third Edition ........................................................................iii

Executive Summary ...............................................................................iv

SECTION 1 Introduction ..........................................................................................1-1

SECTION 2 Job Action Sheets .................................................................................2-1

SECTION 3 Forms ...................................................................................................3-1

Hospital Emergency Incident Command System – Volume II

SECTION 4 HEICS Section Colors and Emergency CodeNomenclature Standardization ..............................................................4-1

SECTION 5 Patient Tracking Chart .........................................................................5-1

SECTION 6 Lesson Plans .........................................................................................6-1

SECTION 7 Lesson Plans - Introduction ..................................................................7-1

SECTION 8 Lesson Plan - Table Top ......................................................................8-1

SECTION 9 Lesson Plan - Table Top Exercise Description......................................9-1

SECTION 10 Lesson Plan - Table Top Participant Scenario.....................................10-1

SECTION 11 Lesson Plan - Table Top Supplemental Scenarios...............................11-1

SECTION 12 Lesson Plan - Train-the-Trainer .........................................................12-1

SECTION 13 Sample Policies and Procedures .........................................................13-1

SECTION 14 Resource Directory .............................................................................14-1

SECTION 15 HEICS Glossary .................................................................................15-1

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The San Mateo County Emergency Medical Services would like to gratefully acknowledge thegenerous contributions made by the Hospital Emergency Incident Command System Revision Task

Force. The leadership and commitment to medical disaster preparedness displayed by theseindividuals has assisted many in this country and around the globe.

Lisa Angell, R.N.Watsonville Community Hospital

Watsonville, California

Donald Cheu, M.D.County of San Mateo,

Emergency Medical Services AgencySan Mateo, California

Anne Cheverton, R.N.Western Medical Center - Santa Ana

Santa Ana, California

James Miller, M.S.Washoe Medical Center

Reno, Nevada

Denise Mitchell, R.N.City of Anaheim Fire Department

Anaheim, California

Ellen Nave, B.S.County of San Mateo,


Christine Jakel-Patrick, M.P.H.Kaiser Foundation Hospital Fresno

Fresno, California

Barbara Pletz, R.N.County of San Mateo,


Jeffrey RubinState of California

Emergency Medical Services AuthoritySacramento, California

Paul M. Russell, RNHEICS III Revision Project Coordinator

San Clemente, California

Mitchell Saruwatari, MPHCounty of Los Angeles

Emergency Medical Services AgencyLos Angeles, California

Judy Scott, R.N.San Joaquin County General Hospital

Stockton, California

Joyce TutaloSan Mateo County General Hospital

San Mateo, California

Mark Wallerstein, R.N.County of Los Angeles

Emergency Medical Services AgencyLos Angeles, California

Recognition and appreciation is extended to the following individuals and agencies for their significant contribution:

Beverly Thames, San Mateo County Health Services Agency;Claudette Clarke, San Mateo County EMS Agency;

Charla Jensen, State EMS Authority;Allyson S. Brown, MBA, Irvine, California;

Virginia Hastings & Darlene Isbell, R.N., Los Angeles County EMS Agency;Bruce Spurlock, M.D. and the California Healthcare Association;

and Bruce Binder, Veterans Administration Hospital Emergency Preparedness

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Forward to the Third Edition

The Hospital Emergency Incident Command System (HEICS) is astandard by which the medical community has found success and commonground in the area of disaster management. Like the first and secondedition, this third version was completed with a grant from the State ofCalifornia Emergency Medical Services Authority. The County of SanMateo Emergency Medical Services Agency undertook the project toupdate the 1993 HEICS document. A survey of California hospitals in thespring of 1997 indicated that this disaster management plan was thechoice of many hospitals; the medical community had established HEICSas a facility standard in emergency response. From their input newinstructional aids, an introductory video, and informational web pages onthe California EMS Authority’s internet site (www.emsa.cahwnet.gov)were developed. It is now hoped that the success and lessons learnedrelative to HEICS can be shared with hospitals across the nation andaround the globe.

Many respected experts worked on this project; however, they are notresponsible for validating the HEICS plan. It is the many disaster andemergency preparedness coordinators at medical facilities throughout thestate who have made HEICS the standard it is today. This manuscript isdedicated to these individuals.

You will note a few changes to this edition of the HEICS document. Thereis a new executive summary stressing the flexibility of the response plan.The manual is divided into two volumes to place emphasis on the plan’sessentials and facilitate reading. Finally, the resource directory has beentrimmed to include only those items directly related to the HEICS plan. It ishoped that the reader finds these improvements helpful.

The members of the Hospital Emergency Incident Command SystemRevision Task Force are an extraordinary collection of talented individuals.This project was fortunate to have their expertise and benefitedtremendously from their assistance. One individual was especiallyinvolved with most every aspect of the project; including the important taskof project time tracking. Ellen Nave is recognized and thanked for hercommitment to this project.

Paul M. Russell, RNHEICS Third Edition Revision Project Coordinator

v

HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEMThird Edition

EXECUTIVE SUMMARYJanuary, 1998

Confusion and chaos are commonly experienced by the hospital at the onset of a medicaldisaster. However, these negative effects can be minimized if management respondsquickly with structure and a focused direction of activities. The Hospital Emergency IncidentCommand System (HEICS) is an emergency management system which employs a logicalmanagement structure, defined responsibilities, clear reporting channels, and a commonnomenclature to help unify hospitals with other emergency responders. There are clearadvantages to all hospitals using this particular emergency management system.

Based upon public safety’s Incident Command System, HEICS has already proved valuablein helping hospitals serve the community during a crisis and resume normal operations assoon as possible. A survey of California hospitals in the spring of 1997, reveals a significantnumber of hospitals have, or will be incorporating HEICS within their emergency plans. HEICSis fast becoming the standard for health care disaster response and offers the followingfeatures:

• predictable chain of management• flexible organizational chart allows flexible response to specific emergencies

• prioritized response checklists• accountability of position function

• improved documentation for improved

accountability and cost recovery• common language to promote

communication and facilitate outsideassistance

• cost effective emergency planning withinhealth care organizations

The 1996 Edition of the National Fire Protection Association, Health Care Facilities Handbookstates in chapter 11-4.3, “The disaster planning committee shall model the disaster plan on theincident command system (ICS).” The American Society for Healthcare Engineering of theAmerican Hospital Association in an August, 1997 Healthcare Facilities Management Seriesstates “One of the best examples of emergency preparedness through checklists can befound in The Hospital Emergency Incident Command System...” In California, public hospitalsseeking financial recovery following a declared disaster are required to implement the 1993mandates of the Standardized Emergency Management System. The utilization of the HEICSplan is recognized as partial compliance with this act.

HEICS and all of its support material are offered without charge. Implementation templatesand instructional materials are free and make the cost of converting to the HEICS systemminimal. HEICS is financially prudent as it assists the medical facility in staying open followinga disaster and promotes the restoration of day-to-day hospital function. It is an efficientmethod for managing emergencies of disastrous proportions, as well as those of a lesserdegree.

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For More Information...about the Hospital Emergency Incident Command System contact the California EmergencyMedical Services Authority at (916) 322-4336; or visit the web site atwww.emsa.cahwnet.gov/.

vii

PUBLIC INFORMATION

OFFICER

LIAISON

OFFICER

SAFETY & SECURITY

OFFICER

D A M A G E A S S E S S M E N T

AND CONTROL OFFICER

SANITATION SYSTEMS

OFFICER

FACILITY UNIT LEADER

COMMUNICATIONS UNIT LEADER

TRANSPORTATION UNIT LEADER

MATERIALS SUPPLY UNIT LEADER

NUTRITIONAL SUPPLY UNIT LEADER

LOGISTICS

CHIEF

SITUATION - STATUS UNIT LEADER

LABOR POOL UNIT LEADER

MEDICAL STAFF POOL UNIT LEADER

PATIENT TRACKING OFFICER

PATIENT INFORMATION OFFICER

NURSING UNIT LEADER

PLANNING

CHIEF

TIME UNIT LEADER

PROCURMENT UNIT LEADER

CLAIMS UNIT LEADER

COST UNIT LEADER

FINANCE

CHIEF

MEDICAL STAFF

DIRECTOR

SURGICAL SERVICES

UNIT LEADER

MATERNAL - CHILD

UNIT LEADER

CRITICAL CARE

UNIT LEADER

GENERAL NURSING CARE

UNIT LEADER

OUTPATIENT SERVICES

UNIT LEADER

IN-PATIENT AREAS

SUPERVISOR

TRIAGE

UNIT LEADER

IMMEDIATE TREATMET

UNIT LEADER

DELAYED TREATMENT

UNIT LEADER

MINOR TREATMENT

UNIT LEADER

DISCHARGE

UNIT LEADER

MORGUE

UNIT LEADER

TREATMENT AREAS

SUPERVISOR

MEDICAL CARE

DIRECTOR

LABORATORY

UNIT LEADER

RADIOLOGY

UNIT LEADER

PHARMACY

UNIT LEADER

CARDIOPUMONARY

UNIT LEADER

ANCILLARY SERVICES

DIRECTOR

STAFF SUPPORT

UNIT LEADER

PSYCHOLOGICAL SUPPORT

UNIT LEADER

DEPENDENT CARE

UNIT LEADER

HUMAN SERVICES

DIRECTOR

OPERATIONS

CHIEF

INCIDENT COMMANDER

The Hospital EmergencyIncident Command System(HEICS)

This organizational chart represents the response portion of a hospital’semergency or disaster plan. The HEICS management system fits withina facility’s overall Emergency Preparedness Plan, and is supported bypolicies and procedures which outline this response plan’s activation.

ix

HEICS is an emergency management system made up of positions on an organizationalchart. Each position has a specific mission to address an emergency situation. Eachposition represented above has an individual checklist designed to direct the assignedindividual in disaster recovery tasks. The HEICS plan includes forms to enhance this overallsystem and promote accountability.

The HEICS plan is flexible. Only those positions, or functions, which are needed should beactivated. The HEICS plan allows for the addition of needed positions, as well as thedeactivating of positions at any time. This equates to promoting efficiency and costeffectiveness. The above chart may be fully activated for a large, extended disaster such asan earthquake. However, full activation may take hours or even days. The majority ofdisasters or emergencies will require the activation of far fewer positions.

More that one position may be assigned to an individual. Situations of a critical nature mayrequire an individual to perform multiple tasks until additional support can be obtained. Thisis made possible with the use of the individual position checklists.

xi

MINIMAL STAFFING

LIAISON

OFFICER

SAFETY & SECURITYOFFICER


TRANSPORTATIONUNIT LEADER

LOGISTICSCHIEF

SITUATION - STATUSUNIT LEADER



MEDICAL STAFF

DIRECTOR

SURGICAL SERVICES

UNIT LEADER TRIAGEUNIT LEADER

IMMEDIATETREATMETUNIT LEADER

DELAYEDTREATMENTUNIT LEADER

MINORTREATMENTUNIT LEADER

DISCHARGEUNIT LEADER

MORGUEUNIT LEADER

TREATMENT AREAS

SUPERVISOR

MEDICAL CARE

DIRECTOR

LABORATORYUNIT LEADER

RADIOLOGYUNIT LEADER

PHARMACY

UNIT LEADER

CARDIOPUMONARYUNIT LEADER

PSYCHOLOGICALSUPPORT

UNIT LEADER

OPERATIONSCHIEF

INCIDENT COMMANDER

A bus crash in the early A.M. hours will find hospital management and staff at a minimum. The HEICS system allows a minimum activation ofpositions necessary to care for the arriv ing injured. The 5 positions with double-boxed borders are those which should be immediately activatedupon notice of the crash. The other positions can be added as more personnel arrive. It should be remembered that a person might be required toperform more than one job. As more staff becomes available they relieve the indiv idual with multiple assignments. For example: the Night Superv isorinitially becomes the Incident Commander and Labor Pool Unit Leader. Tasks (positions) which are assigned a high priority may be div ided amongarriv ing (available) indiv iduals.

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FLEXIBILITY

P U B L I C I N F O R M A T I O NO F F I C E R

L I A I S O NO F F I C E R

S A F E T Y & S E C U R I T YO F F I C E R

D A M A G E A S S E S S M E N TA N D C O N T R O L O F F I C E R

S A N I T A T I O N S Y S T E M SO F F I C E R

F A C I L I T Y U N I T L E A D E R

C O M M U N I C A T I O N S U N I T L E A D E R

T R A N S P O R T A T I O N U N I T L E A D E R

M A T E R I A L S S U P P L Y U N I T L E A D E R

N U T R I T I O N A L S U P P L Y U N I T L E A D E R

L O G I S T I C SC H I E F

S I T U A T I O N - S T A T U S U N I T L E A D E R

L A B O R P O O L U N I T L E A D E R

M E D I C A L S T A F F P O O L U N I T L E A D E R

P A T I E N T T R A C K I N G O F F I C E R

P A T I E N T I N F O R M A T I O N O F F I C E R

N U R S I N G U N I T L E A D E R

P L A N N I N GC H I E F

T I M E U N I T L E A D E R

P R O C U R M E N T U N I T L E A D E R

C L A I M S U N I T L E A D E R

C O S T U N I T L E A D E R

F I N A N C EC H I E F

M E D I C A L S T A F FD I R E C T O R

S U R G I C A L S E R V I C E SU N I T L E A D E R

M A T E R N A L - C H I L DU N I T L E A D E R

C R I T I C A L C A R EU N I T L E A D E R

G E N E R A L N U R S I N G C A R EU N I T L E A D E R

O U T P A T I E N T S E R V I C E SU N I T L E A D E R

I N - P A T I E N T A R E A SS U P E R V I S O R

T R I A G EU N I T L E A D E R

I M M E D I A T E T R E A T M E TU N I T L E A D E R

D E L A Y E D T R E A T M E N TU N I T L E A D E R

M I N O R T R E A T M E N TU N I T L E A D E R

D I S C H A R G EU N I T L E A D E R

M O R G U EU N I T L E A D E R

T R E A T M E N T A R E A SS U P E R V I S O R

M E D I C A L C A R ED I R E C T O R

L A B O R A T O R YU N I T L E A D E R

R A D I O L O G YU N I T L E A D E R

P H A R M A C YU N I T L E A D E R

C A R D I O P U M O N A R YU N I T L E A D E R

A N C I L L A R Y S E R V I C E SD I R E C T O R

S T A F F S U P P O R TU N I T L E A D E R

P S Y C H O L O G I C A L S U P P O R TU N I T L E A D E R

D E P E N D E N T C A R EU N I T L E A D E R

H U M A N S E R V I C E SD I R E C T O R

O P E R A T I O N SC H I E F

I N C I D E N T C O M M A N D E R

T h e a c t i v a t i o n o f p o s i t i o n s f o r a m a s s c a s u a l t y a c c i d e n t w i l l b e d i f f e r e n t t h a n t h o s e a c t i v a t e d f o r a h a z a r d o u s m ater ia l sp i l lo r an im p e n d i n g l a b o r s t r i k e . H E I C S w i l l f l e x t o a c c o m m o d a t e t h e u n i q u e n e e d s o f e a c h e m e r g e n c y . T h e a b o v e c h a r ti l l us t ra tes the pos i t i ons wh ich may be opened to add ress i ssues assoc ia ted w i th a s to rm a le r t . Th is p re -d i sas te r ac t i va t i on a l l ows a le r t ed s ta f f t o be i n a “s t a n d - b y ” m o d e i n t h e e v e n t f u t u r e p o s i t i o n s n e e d t o b e f i l l e d . K e e p i n m i n d , e a c h e m e r g e n c y has i t s own se t o f p r i o r i t i es and c i r cum s tances . W i th easy to unde rs tand , p re -wr i t t en check l i s t s , a lm o s t a n y o n e c a n a s s u m e a ro l e a f t e r a f ew m inu tes o f r ead ing .

xi

COST EFFECTIVE

COST EFFECTIVE ACTIVATION - of a facility’s emergency plan will occur as a resultof more efficient use of available personnel resource. Financial resources are savedby activating only those positions which are necessary.

COST EFFECTIVE IMPLEMENTATION -previous years of development and testinghave created proven universal forms andprocedures which need only to be customizedfor the facility. Disaster planning activities alsoserve as tangible disaster mitigation efforts.

COST EFFECTIVE TRAINING - is generic andbasic to all hospital employees. Most trainingcan be done in the annual update format ofeach facility. Employees coming from otherinstitutionsmay already be schooled in the IncidentCommand System.

For More Information...

about the Hospital Emergency Incident Command System contact the CaliforniaEmergency Medical Services Authority web site at www.emsa.cahwnet.gov/ ortelephone the Authority at (916) 322-4336.

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Hospital Emergency Incident Command System - Volume I

SECTION 1

INTRODUCTION

TO

H E I C S

1 - 2

INTRODUCTION TO THEHOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM

INTRODUCTION

The Hospital Emergency Incident Command System (HEICS) was developed to assist the operation of amedical facility in a time of crisis. The second edition of the HEICS manual is significantly morecomprehensive than the original version developed in 1991. This third edition remains essentially unchangedfrom its May, 1993 predecessor. Some of the additions made to the second edition included introductory textdealing with implementation of the HEICS program into a medical facility. The organizational chart wasrevised to include a subsection addressing the care of the hospital's in-patients. The Job Action Sheets werereformatted for easier reading. Lesson plans were added to facilitate instruction of the hospital staff and thetraining of other instructors. Each chapter has an introduction to explain the purpose and use of the material.Chapter introductions, added in the second edition of HEICS, were originally intended to be instructional andself-prompting. Experience over the years has pointed to the reality that a certain degree of outside supportmay be necessary to integrate HEICS into a medical facility’s culture. An experienced instructor or tour of afacility using HEICS may be necessary to assist a hospital’s transition to the incident command style ofmanagement.

This third edition of the HEICS manual is the joint property of the State Emergency Medical ServicesAuthority and the San Mateo County Emergency Medical Services Agency. All material is provided toinstitutions for their private use and adaptation within each facility/facilities. Institutions are encouraged tomake full use of the material provided in this manual, so long as it is used for that specific facility or facilitiesmanaged by the same parent organization. This includes the direct use or adaptation or copying of any JobAction Sheet, lesson plan or other information contained in this manuscript. Any other use or publication ofthis material must have the written permission of the State EMS Authority. You are asked that when using thismaterial credit be given to the State of California Emergency Medical Services Authority.

HISTORY OF THE HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM

In the 1980's an inter-agency (local, State and Federal) cooperative effort was formed to develop a commonorganizational system which fire protection agencies could use in response to a very large incident, as well assmaller day-to-day operations. The cooperative plan known as FIRESCOPE, directed by the National Inter-Agency Incident Management System, produced a management system which has become a standard operatingprocedure for fire departments across the United States. The process, known as the Incident Command System(ICS), is utilized by most every fire department in the State of California. It is finding acceptance in firedepartments across the United States and Canada and is now being integrated into other civil service areas andthe private sector.

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In 1987, the Hospital Council of Northern California completed work on an adaptation of the ICS to hospitalemergency response functions in a publication entitled Earthquake Preparedness Guidelines for Hospitals.That document served as a corner stone in the development of the original Hospital Emergency IncidentCommand System (HEICS) written by Orange County Emergency Medical Services in 1991 with a grant fromthe State of California Emergency Medical Services Authority. In 1992 Orange County EMS began work onthe second edition of the HEICS, again, with a funding provided by the State EMS Authority. This majorrewriting of the HEICS was done with the intention of making the original document easier to use andimplement within the hospital environment. The second edition attempted to retain those same characteristicsthat made the original ICS-based plan so appealing. This third edition of HEICS is produced by the County ofSan Mateo Emergency Medical Services Agency; again, with a grant from the State EMS Authority. TheProject began in the fall of 1996 with the intention of gathering data regarding the usage of HEICS. From thisinput, a revised edition of HEICS would be recreated. However, a survey of California acute care hospitals inthe spring of 1997 revealed no major concerns regarding the currently used HEICS plan. What was discoveredwas that there needed to be a better understanding regarding the adaptability and flexibility of HEICS tofacilities of all sizes and emergencies of all types. The original attributes remain as before. They include thefollowing:

? Responsibility oriented chain of command

This is an organizational structure which provides for the addressing of many facetsof an emergency. It provides a manageable scope of supervision for allfunctions/positions.

? Wide acceptance through commonality of mission and language

Through the use of a broadly accepted organizational chart and generic positiontitles, the ICS system has found expanding acceptance in both public and privatebased management circles.

? Prioritization of duties with the use of Job Action Sheets

The Job Action Sheets are position job descriptions which have a prioritized list ofemergency response tasks. The Job Action Sheets also serve as reminders of thelines of reporting and promote the documentation of the incident.

? Applicability to varying types and magnitudes of emergency events

The HEICS is a flexible program which can be expanded or scaled back to meet theparticular needs of a specific crisis.

? Thorough documentation of actions taken in response to the emergency.

The Job Action Sheets and the associated forms promote vigorous documentation ofboth personnel and overall facility response to the crisis. This comprehensivedocumentation may improve recovery of financial expenditures, while it decreasesliabilities.

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? Expeditious transfer of resources (mutual aid) within a particular system or from one facilityto another

The idea of sharing material and human resources in time of need is not new tohospitals. Mutual aid among medical institutions will be facilitated which a commonsystem of management and terms.

? Flexibility in implementation of individual sections or branches of the HEICS

Activation of the HEICS based plan can be customized to meet the needs of aparticular crisis.

? Minimal disruption to existing hospital departments by virtue of parallel jobqualifications/duties

The HEICS Organizational Chart and Job Action Sheets are designed to mitigate acrisis affecting the medical facility. However, it is readily apparent that there aremany individuals within the day-to-day management structure whose jobs closelymatch those of the HEICS.

The HEICS Organizational Chart shows a chain of command which incorporates four sections under theoverall leadership of an Emergency Incident Commander (IC). Each of the four sections: Logistics, Planning,Finance and Operations, has a Chief appointed by the IC responsible for their section. The Chiefs in turndesignate directors and unit leaders to subfunctions, with supervisors and officers filling other crucial roles.This structure limits the span of control of each manager in the attempt to distribute the work. It also providesfor a system of documenting and reporting all emergency response activities. It is hoped that this will lessenliability and promote the recovery of financial expenditures.

Section Chief

Director

Supervisor

Unit Leader

Officer

Emergency Incident Commander

Each one of the forty-nine positions found on the organizational chart has a prioritized Job Action Sheetswritten to describe the important duties of each particular role. Every Job Action Sheet begins with the jobtitle, the supervising officer where the location of the section operations center is and a mission statement todefine the position responsibility. The duties listed on the Job Action Sheet are put into categories of

1 - 5

"Immediate", "Intermediate" and "Extended". A line to the left of the particular action is provided for therecording of the time when the duty was accomplished or last completed.

Where it is necessary to revise particular job descriptions, caution should be used to retain the intent of the JobAction Sheet's mission. Changing the Job Action Sheet title, or position title is not recommended, as there willbe a loss of common nomenclature. Changing titles will only inhibit communication when dealing with outsideagencies. Moving positions to other sections or locations will defeat commonality of structure. Theorganizational structure should remain as pictured in the organizational chart. Standardization of language andchain of command is essential to promote communication and mission achievement both inside the hospital andwith outside entities.

IMPLEMENTATION OF HEICS

In 1991 the administrative staff of the pilot hospitals were introduced to the original HIECS program, trainedand tested the plan in a full functional exercise. This was all accomplished within a three month time spanwith very positive results. While 90 days may be rushing it for some institutions, the length of theimplementation/ transition program for each medical facility will depend upon a variety of factors. The size ofthe institution, the number of people committed to the project, the funds available to promote the project and thestrength of management's support are just some of the factors that will need consideration in the implementationprogram design. The information and tools contained in this second edition will significantly help this process,but the actual implementation time is the decision of management and the HEICS implementation team.

IMPLEMENTATION PROGRAM OUTLINE

The following is an outline of the suggested phases which may be necessary to implement the HospitalEmergency Incident Command System (HEICS) Program into a medical facility.

HEICS Concept Briefing

Someone experienced in the HEICS program briefs interested hospital administrators and emergency planners.The person conducting the briefing may be an employee of the hospital who has attended an educationaloffering on the HEICS; or someone in public health, emergency services or from another hospital which hasalready instituted the system. Utilizing experience and information found in the HEICS lesson plans, thepresenter will provide a general description of the program and the benefits of adapting the facility's emergencyresponse plan to an incident command style of operation. As much detail as possible should be given toAdministration regarding the estimated cost of implementation and maintenance of the HEICS plan. Thesession should conclude with a question and answer session. References should be made available if there isthe desire to contact an individual at another facility which has adopted the HEICS program.

Commitment to Adopt the HEICS Plan

An anticipated result of the above briefing will be the hospital's decision to either accept or reject a plan toimplement the HEICS program within the facility. If there is a commitment to go ahead with the HEICSprogram then a transition team should be appointed. This team should be composed of as many upper levelmanagers as possible. The hospital's Disaster Coordinator should guide the team; but other institutions haveexperienced great success when a vice-president and department head have also been appointed to serve on theHEICS Implementation Team. Needless to say, all who sit on this team should be actively supportive of theconcept and mission. These individuals should have the ability to devote at least five to ten hours per week forone to three months in order to effect the transition. Above all, top level management must make the decision to

1 - 6

stand visibly behind the program. If hospital management and staff are convinced of the CEO and/or Board'sdetermination to enhance the hospital's disaster response the chances of a smooth and successful transition willbe greatly increased.

The remainder of this document assumes that there has been a decision to proceed with the implementation ofthe HEICS.

Establishment of the HEICS Implementation Committee

The HEICS Implementation Committee should be larger that the Implementation Team. It should becomposed of a number of hospital employees of various management levels and from various departments.These employees may be currently serving on the facility's Disaster or Safety Committee. The charge of theImplementation Committee is to put together a comprehensive program to integrate the HEICS into the facility.Some of the duties of the committee are:

? Develop an agenda and time line for the implementation project? Revise the current disaster/emergency plan to incorporate the HEICS? Develop a training schedule and pool of instructors? Ensure the inclusion of HEICS training in the annual employee inservice training program? Develop a pre-training employee awareness and "public relations" programs? Establish an employee disaster preparedness resource center? Requisition the HEICS vests, storage equipment and any other materials related to emergency

management

There may be other projects that the committee may involve themselves with which will promote a positiveattitude toward the hospital's revised emergency response plan.

Management Briefing

A presentation is made to all administrators, department heads and managers regarding the implementation ofthe HEICS program into the facility's emergency response plan will help solidify support in all areas of thehospital. It is very important that this briefing is co-sponsored by the HIECS Implementation Team andCEO/Board representative.

This program should be a combination of education and public relations. Managers should be made to feel thatthey are all an integral part of the new system. Interested managers can be recruited to become part of a train-the-trainer class.

Revision of the Hospital's Disaster/Emergency Plan

The hospital's current disaster plan will need to be configured so that the Incident Command System becomesthe "standard operating procedure" when an the plan is activated. It is important to understand that the HEICSis not the entire disaster plan; but rather the method by which a hospital will operate when an emergency isdeclared. The revision of the facility's emergency plan may be initiated at any point in the implementationprogram, however, the sooner this process is completed the more cohesive the overall plan will appear toinvolved personnel. This may become a important, positive selling point during the general introductory phase.

The HIECS Job Action Sheets and forms might be viewed as the center of a disaster/emergency plan.Surrounding the Job Action Sheets are supporting policies and procedures which augment the HEICS and

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make it work. The following is a short list of some typical P & P which are instrumental in a completeemergency plan:

? Pre-disaster departmental readiness checklists? Policy for activation of the hospital's disaster plan? Policy for termination of the hospital disaster plan? Personnel recall procedures? Security/lock-down policy? Decision to evacuate policy? Evacuation procedure? Volunteer credentialing policy? Policy regarding standing orders for patient care during a disaster? Policy allowing for rapid patient discharge during a disaster

Some facilities have developed annexes, or subsections of the disaster plan, to deal with specific emergenciessuch as hazardous material releases, earthquakes, utility outage, severe weather, bomb/security threat and otherconditions which may potentially occur.

The completed disaster manual will above all be simple. The plan requiring volumes of memorization willeventually collect dust on a shelf. Some of the most effective hospital disaster plans are surprisingly brief andsimple to read. A well indexed text, with brevity as its hallmark, will be considered "user friendly" by thosewho depend upon it.

Introductory Lesson for All Hospital Employees

All employees of the facility are instructed on the HEICS plan. This is done utilizing the Introduction to theHospital Emergency Incident Command System Lesson Plan. It is recommend that all levels and areas ofservice should attend these general education session. The programs are estimated to run approximately onehour. Participants at this training session are made aware of the HEICS plan and how it will affect theirdisaster response. They should be advised that some of them will be invited back to participate in a table topexercise. Ultimately all personnel will be involved when the hospital tests the new plan in a future disasterexercise.

This inservice may be an opportunity to create some positive employee - employer relations by promotingemployee family/home disaster preparedness. Some hospitals have found this to be quite successful inpromoting employee loyalty.

Staff Table Top Exercise

The HEICS Table Top Exercise is a paper drill intended to demonstrate the working and communicationrelationships of functions found within the HEICS organizational plan. The exercise is intended primarily forthe administrators, managers and personnel who could conceivably be placed into an officer's position uponactivation of the disaster plan. The exercise itself will take two to two and a half hours to complete.

Full-Functional Exercise of the HEICS Plan

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The new HEICS disaster response plan may be tested when the facility conducts a general disaster exercise.This will involve the activation and simulated activity of all sections of the Incident Command System. Othermedical facilities have received a highly positive response from employees who have been involved in their first,fully-functional exercise of the HEICS. In three hospitals of 200 beds or more, greater than 80% ofparticipating employees felt that the hospital's disaster exercise performance was more organized than beforethe implementation of the HEICS program. These same hospitals have devoted an adequate amount of pre-training to all employees.

Continuing Staff Education

These periodic sessions are intended to meet licensing/accreditation standards, but also to keep all hospitalresponders committed to disaster preparedness and proficient in emergency operating procedures. Theexpertise of top management in regards the HEICS plan is a priority. The leadership team composed ofmanagers who could potentially fill the of roles of Incident Commander, Administrative officers and sectionchiefs must be always ready and always aware of how the facility's disaster plan works; as well as theresponsibilities associated with the most critical job positions.

Educational offerings may be centered on paper or functional exercises, introduction of new disaster-relatedtopics and review of the MASICS plan. Home and family emergency preparedness should always be stressedat each educational session. General employee classes are usually done at the employee’s anniversary or priorto a scheduled disaster exercise. Smaller educational sessions may be held within department inservices or aspart of a facility-wide safety program. The chapter dealing with lesson plans has additional suggestionsregarding staff education.

Summary Comments

It is believed that the material in this manual is comprehensive enough to allow institutions and individuals tobegin the integration of an incident command system into a hospital's disaster plan. Those who worked on therevision of this document trust that those individuals who are able to grasp the key ideas in this text will be ableto initiate a program like the one outlined here. It is important to keep in mind that the HEICS is a tool tofacilitate accomplishing a task. The HEICS identifies critical management functions in order for the hospital todevelop and implement an emergency action plan. In the end, it is people who are truly the most importantelement of any emergency plan. There is no Job Action Sheet or form or Action Plan which can substitute forthe well trained employee; including the Medical Staff. Training and exercise of the disaster plan builds theconfidence of the entire staff. Honest critiquing will illuminate those areas which are in need of further revisionor retraining. Those officers with a working knowledge of the facility disaster plan will be better able toexercise a command and control presence over those areas assigned to their care. Confidence in management isan essential component of the plan which no hospital administrator should overlook. People who believe inleadership will give their loyalty, as well as their skill.

Finally, there are two types of people who believe in emergency plans. Those who know they are necessary foraccreditation and licensing; and those who believe that they will eventually someday be used. People whodevelop plans for licensing purposes solely will probably not read this. There is really no other driving forceother than to meet a code. For their purposes, any reasonable plan will suffice. The individual who believesthat real emergencies do happen is usually committed to a preparedness philosophy which promotes emergencyplanning at work, home or where ever a person may be. Employee personal disaster preparedness is adeserving venture for the medical facility for a number of reasons. Some of these reasons are practical, such asthe employee who is better prepared at home will be better able to report to work if called. The employer whohas devoted energy to creating a comprehensive emergency plan in the workplace; and has also committed

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some resource towards preparing the worker for an emergency away from the job, is clearly telling theemployee "You are a valuable resource - a most important part of this facility's disaster plan." The employee’sattitude toward the hospital will be one of loyalty and commitment to recovery.

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SECTION 2

JOB ACTION

SHEETS

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The Hospital Emergency Incident Command SystemJob Action Sheets

The Job Action Sheets, or job descriptions, found in this chapter are the essence of the HEICS program. Thisis the component that tells responding personnel "what they are going to do; when they are going to do it; and,who they will report it to after they have done it."

Organizational Charts

The organizational chart shows the variety of positions which may be needed to address an emergencysituation. Another way to view this chart is to think of it, in the words of an Incident Command System (ICS)instructor, as a tool box. All the equipment necessary to perform a job can be found in this "box", however,some tools are used immediately and more often than others. And, so it is with the HEICS OrganizationalChart.

One should try to refrain from thinking that each position represents a person, and each position must be filledas soon as possible. Each of these impressions is false. In conditions of minimum staffing, such as the middleof the night, there are not enough personnel to begin to fill each position. Each crisis is unique and should beconfronted as such. Those positions which will be immediately needed to manage the emergency will be thefirst assignments made. These are the "first tools pulled out of the box." There are some positions or roleswhich are not needed for hours or days after the onset of the emergency. Some may not be needed at all. Itbecomes very clear that the most important abilities needed to react to an emergency circumstance are the skillto identify the priorities created by the event and which positions are most important to mitigate its ill effects.

When it is discovered that there are more jobs to be accomplished than people available, then it may benecessary to delegate more than one job to an individual. Another alternative is to realize that not every taskcan be accomplished at the time it needs to be done. This can lead to a re-prioritization of needs. In otherwords, there are limitations in resources which may need to be recognized. This uncomfortable realization maystimulate a revision in the manner in which day-to-day management is performed, or a change in your facility'semergency plan.

Following the Organizational Chart is a chart identified as a" Crosswalk". The crosswalk chart is a listing ofpossible positions which might have day-to-day responsibilities similar to those found in the Job Action Sheets.While it is not recommended that these be the only people trained for each position, it is reasonable to visualizehow these individuals may be a logical first choice for filling a particular role. It must be remembered that theflexibility of having managers assume almost any officer's role is an important attribute to be retained in theHEICS program.

The blank organizational chart entitled "Worksheet" is provided to assist the reader in identifying positionswithin their own facility which may provide leadership in a key HEICS position.

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Job Action Sheets

The Job Action Sheets were the basis for the first HEICS manual written in the spring of 1991. They havebeen revised and expanded to more clearly address to the issues a health care facility may face in a crisis.These sheets should be closely examined and, if needed, altered to meet the needs of the facility.

There are two components of the Job Action Sheets which should not be changed under any circumstances.These areas are the job title and the mission statement. The HEICS plan was designed to closely emulate theIncident Command System developed by the FIRESCOPE organization in the late '70's/early '80's. ICS hasbeen and continues to be adopted by many public and private agencies. In part, because it is a known standard.The universal titles and mission statements found in HIECS allow emergency responders from a variety oforganizations to communicate quickly and clearly with other subscribers to the ICS style of management.Changing job titles and responsibilities (mission statements) would counter-serve the purpose which helpeddesigned this program.

Presentation and Storage of Job Action Sheets

Job Action Sheets which are found within the facility's general emergency/disaster plan are sufficient to meetinspection and code requirements. In order to make them useful at the time they are needed, a system ofpresentation and storage should be developed.

Other hospitals have experienced success in laminating each Job Action Sheet in plastic so that the time of dutycompletion can be marked in the blank to the left of the duty. Using an erasable grease pen would allow areuse of the sheet. Another approach would be to place the Job Action Sheet inside a clear plastic clipboard.Color coded clipboards coordinated with the color of the ICS section are also available.

One hospital has reduced the Job Action Sheets into a pocket sized booklet, similar to one used by some fireservices. This booklet contains key job descriptions, telephone numbers and maps locating the various specialareas that are established following a declared emergency.

Grouping the Job Action Sheets by section is the common sense approach in organizing and storing thesecommand materials. This has been made easier by utilizing a color coded, plastic storage crate. A campingfood chest has also been used to store the section's Job Action Sheets, identification vests and forms/suppliesnecessary to carry out the section's mission. At the time of the declared disaster these crates or chests would begiven to each section chief for further dissemination.

In summary, the customizing of the Job Action Sheets and their distribution should result in making theimplementation of the hospital's disaster plan as "user friendly" as possible. In time of crisis, the simpler a taskcan be made, the better its chances of being completed.

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEMOrganizational Chart

Public Information Officer Liaison Officer

Safety and Security Officer

Damage Assessment andControl Officer

Sanitation SystemsOfficer

FacilityUnit Leader

CommunicationsUnit Leader

TransportationUnit Leader

Materials SupplyUnit Leader

Nutritional SupplyUnit Leader

Logistics Chief

Situation-StatusUnit Leader

Labor PoolUnit Leader

Medical StaffUnit Leader

Patient TrackingOfficer

Patient InformationOfficer

NursingUnit Leader

Planning Chief

TimeUnit Leader

ProcurementUnit Leader

ClaimsUnit Leader

CostUnit Leader

Finance Chief

Medical StaffDirector

Surgical ServicesUnit Leader

Maternal ChildUnit Leader

Critical CareUnit Leader

General Nursing CareUnit Leader

Out Patient ServicesUnit Leader

In-Patient AreasSupervisor

TriageUnit Leader

Immediate TreatmentUnit Leader

Delayed TreatmentUnit Leader

Minor TreatmentUnit Leader

DischargeUnit Leader

MorgueUnit Leader

Treatment AreasSupervisor

Medical CareDirector

LaboratoryUnit Leader

RadologyUnit Leader

PharmacyUnit Leader

CardiopulomonaryUnit Leader

Ancillary ServicesDirector

Staff SupportUnit Leader

Psychological SupportUnit Leader

Dependent CareUnit Leader

Human ServicesDirector

Operations Chief

IncidentCommander

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEMORGANIZATIONAL CHART CROSSWALK

Public/Comm Relations Disaster Coordinator

Director of Safety-Security

Engineer in Charge ofLife Safety Systems

Director ofEnvironmental Service

Chief ofEngineering

Director ofCommunications

Patient/Guest TransportationCoordinator

Director ofMaterials Mgmt

Director ofNutritional Services

Vice-Pres of Facilities

Information SystemsManager

Director ofHuman Resources

Director of MedicalStaff Services

AdmittingSupervisor

Patient RelationsCoordinator

Director ofNursing

Sr VP Asst Admin

PayrollManager

Controller -Contracts

RiskManager

AccountsManager

CFO Financial VP

Chief of SurgeryED Physician

Operating RoomService Supervisor

Maternal ChildService Supervisor

Special Care ServiceCharge Nurse

Medical'SurgicalNursing Supervisor

Outpatient ServicesSupervisor

Nursing ShiftSupervisor

ED TriageNurse

Emergency/TraumaRN Supervisor

ICU ChargeNurse

ER/OutpatientCharge Nurse

DischargePlanning RN

Pathology LabManager

Emergency DeptSupervisor

Critical CareSupervisor

Pulmonary DeptSupervisor

Director ofLaboratory

Director ofRadiology

Director of Cardiologyor Pulmonary

Ancillary ServicesBranch

Employee HealthManager

PsychiatristPsychologist

Employee BenefitCoordinator

Director ofSocial Services

V.P. of Operations

AdministratorCEO

The positions found on this chart are offered only as suggestions to fill the functional roles found on the HEICS Organization Chart

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEMOrganizational Chart Worksheet

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EMERGENCY INCIDENT COMMAND SYSTEM EMERGENCY INCIDENT COMMANDER

Job Action Sheet Revised: 5-93 Reviewed: 6-98

EMERGENCY INCIDENT COMMANDER

Mission: Organize and direct Emergency Operations Center (EOC). Give overall direction for hospitaloperations and if needed, authorize evacuation.

Immediate ____ Initiate the Hospital Emergency Incident Command System by assuming role ofEmergency Incident Commander.

____ Read this entire Job Action Sheet.____ Put on position identification vest.____ Appoint all Section Chiefs and the Medical Staff Director positions; distribute the four

section packets which contain:? Job Action Sheets for each position? Identification vest for each position? Forms pertinent to Section & positions

____ Appoint Public Information Officer, Liaison Officer, and Safety and Security Officer;distribute Job Action Sheets. (May be pre-established.)

____ Announce a status/action plan meeting of all Section Chiefs and Medical StaffDirector to be held within 5 to 10 minutes.

____ Assign someone as Documentation Recorder/Aide.____ Receive status report and discuss an initial action plan with Section Chiefs and

Medical Staff Director. Determine appropriate level of service during immediateaftermath.

____ Receive initial facility damage survey report from Logistics Chief, if applicable,evaluate the need for evacuation.

____ Obtain patient census and status from Planning Section Chief. Emphasize proactiveactions within the Planning Section. Call for a hospital-wide projection report for 4, 8,24 & 48 hours from time of incident onset. Adjust projections as necessary.

____ Authorize a patient prioritization assessment for the purposes of designatingappropriate early discharge, if additional beds needed.

____ Assure that contact and resource information has been established with outsideagencies through the Liaison Officer.

Intermediate ____ Authorize resources as needed or requested by Section Chiefs.____ Designate routine briefings with Section Chiefs to receive status reports and update the

action plan regarding the continuance and termination of the action plan.____ Communicate status to chairperson of the Hospital Board of Directors or the

designee.____ Consult with Section Chiefs on needs for staff, physician, and volunteer responder

food and shelter. Consider needs for dependents. Authorize plan of action.Extended ____ Approve media releases submitted by P.I.O.

____ Observe all staff, volunteers and patients for signs of stress and inappropriatebehavior. Report concerns to Psychological Support Unit Leader. Provide for staffrest periods and relief.

____ Other concerns:

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM PUBLIC INFORMATION OFFICER


PUBLIC INFORMATION OFFICER (P.I.O.)

Position Assigned To:

You Report To: (Emergency Incident Commander)

Command Center: Telephone:

Mission: Provide information to the news media.

Immediate ____ Receive appointment from Emergency Incident Commander.____ Read this entire Job Action sheet and review organizational chart on back.____ Put on position identification vest.____ Identify restrictions in contents of news release information from Emergency Incident

Commander.____ Establish a Public Information area away from E.O.C. and patient care activity.

Intermediate ____ Ensure that all news releases have the approval of the Emergency IncidentCommander.

____ Issue an initial incident information report to the news media with the cooperation ofthe Situation-Status Unit Leader. Relay any pertinent data back to Situation-StatusUnit Leader.

____ Inform on-site media of the physical areas which they have access to, and those whichare restricted. Coordinate with Safety and Security Officer.

____ Contact other at-scene agencies to coordinate released information, with respectiveP.I.O.s. Inform Liaison Officer of action.

Extended ____ Obtain progress reports from Section Chiefs as appropriate.____ Notify media about casualty status.____ Direct calls from those who wish to volunteer to Labor Pool. Contact Labor Pool to

determine requests to be made to the public via the media.____ Observe all staff, volunteers and patients for signs of stress and inappropriate

behavior. Report concerns to Psychological Support Unit Leader. Provide for staffrest periods and relief.


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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM LIAISON OFFICER


LIAISON OFFICER

Positioned Assigned To:



Mission: Function as incident contact person for representatives from other agencies.

Immediate ____ Receive appointment from Emergency Incident Commander.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander.____ Establish contact with Communications Unit Leader in E.O.C. Obtain one or more

aides as necessary from Labor Pool.____ Review county and municipal emergency organizational charts to determine

appropriate contacts and message routing. Coordinate with Public InformationOfficer.

____ Obtain information to provide the interhospital emergency communication network,municipal E.O.C. and/or county E.O.C as appropriate, upon request. The followinginformation should be gathered for relay:

? The number of "Immediate" and "Delayed" patients that can be received andtreated immediately (Patient Care Capacity).

? Any current or anticipated shortage of personnel, supplies, etc.? Current condition of hospital structure and utilities (hospital's overall

status).? Number of patients to be transferred by wheelchair or stretcher to another

hospital.? Any resources which are requested by other facilities (i.e., staff, equipment,

supplies).____ Establish communication with the assistance of the Communication Unit Leader with

the interhospital emergency communication network, municipal E.O.C. or with countyE.O.C./County Health Officer. Relay current hospital status.

____ Establish contact with liaison counterparts of each assisting and cooperating agency(i.e., municipal E.O.C.). Keeping governmental Liaison Officers updated on changesand development of hospital's response to incident.

Intermediate ____ Request assistance and information as needed through the interhospital emergencycommunication network or municipal/county E.O.C.

____ Respond to requests and complaints from incident personnel regarding inter-organization problems.

____ Prepare to assist Labor Pool Unit Leader with problems encountered in the volunteercredentialing process.

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____ Relay any special information obtained to appropriate personnel in the receivingfacility (i.e., information regarding toxic decontamination or any special emergencyconditions).

Extended ____ Assist the Medical Staff Director and Labor Pool Unit Leader in soliciting physiciansand other hospital personnel willing to volunteer as Disaster Service Workers outsideof the hospital, when appropriate.

____ Inventory any material resources which may be sent upon official request and methodof transportation, if appropriate.

____ Supply casualty data to the appropriate authorities; prepare the following minimumdata:

? Number of casualties received and types of injuries treated? Number hospitalized and number discharged to home or other facilities? Number dead? Individual casualty data: name or physical description, sex, age, address,

seriousness of injury or condition____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM SAFETY AND SECURITY OFFICER


SAFETY AND SECURITY OFFICER




Mission: Monitor and have authority over the safety of rescue operations and hazardous conditions.Organize and enforce scene/facility protection and traffic security.

Immediate ____ Receive appointment from Emergency Incident Commander.____ Read this entire Job Action sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain a briefing from Emergency Incident Commander.____ Implement the facility's disaster plan emergency lockdown policy and personnel

identification policy.____ Establish Security Command Post.____ Remove unauthorized persons from restricted areas.____ Establish ambulance entry and exit routes in cooperation with Transportation Unit

Leader.____ Secure the E.O.C., triage, patient care, morgue and other sensitive or strategic areas

from unauthorized access.Intermediate ____ Communicate with Damage Assessment and Control Officer to secure and post non-

entry signs around unsafe areas. Keep Safety and Security staff alert to identify andreport all hazards and unsafe conditions to the Damage Assessment and ControlOfficer.

____ Secure areas evacuated to and from, to limit unauthorized personnel access.____ Initiate contact with fire, police agencies through the Liaison Officer, when necessary.____ Advise the Emergency Incident Commander and Section Chiefs immediately of any

unsafe, hazardous or security related conditions.____ Assist Labor Pool and Medical Staff Unit Leaders with credentialing/screening

process of volunteers. Prepare to manage large numbers of potential volunteers.____ Confer with Public Information Officer to establish areas for media personnel.____ Establish routine briefings with Emergency Incident Commander.____ Provide vehicular and pedestrian traffic control.____ Secure food, water, medical, and blood resources.____ Inform Safety & Security staff to document all actions and observations.____ Establish routine briefings with Safety & Security staff.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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HOSPITAL EMERGENCY INCIDENT SYSTEM LOGISTICS SECTION

Job Action Sheet Logistics Section Chief

Revised: 5-93 Reviewed: 6-98

LOGISTICS SECTION CHIEF



Logistics Command Center: Telephone:

Mission: Organize and direct those operations associated with maintenance of the physicalenvironment, and adequate levels of food, shelter and supplies to support the medicalobjectives.

Immediate ____ Receive appointment from the Emergency Incident Commander. Obtain packetcontaining Section's Job Action Sheets, identification vests and forms.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander.____ Appoint Logistics Section Unit Leaders: Facilities Unit Leader, Communications Unit

Leader, Transportation Unit Leader, Material's Supply Unit Leader, NutritionalSupply Unit Leader; distribute Job Action Sheets and vests. (May be pre-established.)

____ Brief unit leaders on current situation; outline action plan and designate time for nextbriefing.

____ Establish Logistics Section Center in proximity to E.O.C..____ Attend damage assessment meeting with Emergency Incident Commander, Facility

Unit Leader and Damage Assessment and Control Officer.Intermediate ____ Obtain information and updates regularly from unit leaders and officers; maintain

current status of all areas; pass status info to Situation-Status Unit Leader.____ Communicate frequently with Emergency Incident Commander.____ Obtain needed supplies with assistance of the Finance Section Chief, Communications

Unit Leader and Liaison Unit Leader.Extended ____ Assure that all communications are copied to the Communications Unit Leader.

____ Document actions and decisions on a continual basis.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM LOGISTICS SECTION

Job Action Sheet Facility Unit Leader


FACILITY UNIT LEADER


You Report To: (Logistics Section Chief)


Mission: Maintain the integrity of the physical facility to the best level. Provide adequateenvironmental controls to perform the medical mission.

Immediate ____ Receive appointment from Logistics Section Chief and Job Action Sheets for DamageAssessment and Control Officer, and Sanitation Systems Officer.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Meet with Logistics Section Chief to receive briefing and develop action plan; deliver

preliminary report on the physical status of the facility if available.____ Appoint Damage Assessment and Control Officer and Sanitation Systems Officer;

supply the corresponding Job Action Sheets. Provide the Facility System StatusReport Form to the Damage Assessment and Control Officer. (May be pre-established.)

____ Receive a comprehensive facility status report as soon as possible from DamageAssessment and Control Officer.

____ Facilitate and participate in damage assessment meeting between Emergency IncidentCommander, Logistics Section Chief and Damage Assessment and Control Officer.

Intermediate ____ Prepare for the possibility of evacuation and/or the relocation of medical servicesoutside of existing structure, if appropriate.

____ Receive continually updated reports from the Damage Assessment and ControlOfficer, and Sanitation Systems Officer.

Extended ____ Forward requests of outside service providers/ resources to the Materials Supply UnitLeader after clearing through the Logistics Section Chief.

____ Document actions and decisions on a continual basis. Obtain the assistance of adocumentation aide if necessary.



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Job Action Sheet Damage Assessment and Control Officer


DAMAGE ASSESSMENT AND CONTROL OFFICER


You Report To: (Facility Unit Leader)


Mission: Provide sufficient information regarding the operational status of the facility for the purposeof decision/policy making, including those regarding full or partial evacuation. Identify safeareas where patients and staff can be moved if needed. Manage fire suppression, search andrescue and damage mitigation activities.

Immediate ____ Receive appointment, Job Action Sheet and Facility System Status Report form fromFacility Unit Leader.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Facility Unit Leader.____ Assign teams to check system components of entire facility, and report back within 5

minutes.____ Identify hazards, e.g. fire and assign staff to control and eliminate.____ Receive initial assessment/damage reports and immediately relay information in a

briefing to Emergency Incident Commander, Logistics Section Chief and Facility UnitLeader; follow-up with written documentation.

____ Notify Safety & Security Officer of unsafe areas and other security problems.____ Assemble light-duty search rescue team(s) to retrieve victims and deliver to Triage

Area. Obtain Search and Rescue Team equipment pack from Materials Supply UnitLeader.

____ Notify Labor Pool of staffing needs.____ Identify areas where immediate repair efforts should be directed to restore critical

services.Intermediate ____ Arrange to have structural engineer under contract report and obtain more definitive

assessment if indicated.____ Inspect those areas of reported damage and photographically record.____ Identify areas where immediate salvage efforts should be directed in order to save

critical services and equipment.Extended ____ Assign staff to salvage operations.

____ Assign staff to repair operations.____ Brief Facility Unit Leader routinely to provide current damage/recovery status.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to Psychological Support Unit Leader. Provide for staff rest periods and relief.____ Other concerns:

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Job Action Sheet Sanitation Systems Officer


SANITATION SYSTEMS OFFICER


You Report To: (Facility Unit Leader)


Mission: Evaluate and monitor the patency of existing sewage and sanitation systems. Enact pre-established alternate methods of waste disposal if necessary.

Immediate ____ Receive appointment and Job Action Sheet from Facility Unit Leader.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Facility Unit Leader.____ Coordinate the inspection of the hospital's sewage system with Damage Assessment

and Control Officer.____ Inspect the hazardous waste collection areas(s) to ensure patency of containment

measures. Cordon off unsafe areas with assistance of the Safety & Security Officer.____ Control observed hazards, leaks or contamination with the assistance of the Safety &

Security Officer and the Damage Assessment and Control Officer.____ Report all findings and actions to the Facility Unit Leader. Document all observations

and actions.Intermediate ____ Implement pre-established alternative waste disposal/collection plan, if necessary.

____ Assure that all sections and areas of the hospital are informed of the implementation ofthe alternative waste disposal/collection plan.

____ Position portable toilets in accessible areas; away from patient care and foodpreparation.

____ Ensure an adequate number of handwashing areas are operational near patientcare/food preparation areas, and adjacent to portable toilet facilities.

____ Inform Infection Control personnel of actions and enlist assistance where necessary.Extended ____ Monitor levels of all supplies, equipment and needs relevant to all sanitation

operations.____ Brief Facility Unit Leader routinely on current condition of all sanitation operations;

communicate needs in advance.____ Obtain support staff as necessary from Labor Pool.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Communications Unit Leader






Mission: Organize and coordinate internal and external communications; act as custodian of alllogged/documented communications.

Immediate ____ Receive appointment from Logistics Section Chief.____ Read this entire Job Action Sheet and review organizational chart back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander or Logistics Section Chief.____ Establish a Communications Center in close proximity to E.O.C.____ Request the response of assigned amateur radio personnel assigned to facility.____ Assess current status of internal and external telephone system and report to Logistics

Section Chiefs and Damage Assessment and Control Officer.____ Establish a pool of runners and assure distribution of 2-way radios to pre-designated

areas.____ Use pre-established message forms to document all communication. Instruct all

assistants to do the same.____ Establish contact with Liaison Officer.____ Receive and hold all documentation related to internal facility communications.____ Monitor and document all communications sent and received via the interhospital

emergency communication network or other external communication.Intermediate ____ Establish mechanism to alert Code Team and Fire Suppression Team to respond to

internal patient and/or physical emergencies, i.e. cardiac arrest, fires, etc..Extended ____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Transportation Unit Leader


TRANSPORTATION UNIT LEADER




Mission: Organize and coordinate the transportation of all casualties, ambulatory and non-ambulatory.Arrange for the transportation of human and material resources to and from the facility.

Immediate ____ Receive appointment from Logistics Section Chief.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Logistics Section Chief.____ Assess transportation requirements and needs for patients, personnel and materials;

request patient transporters from Labor Pool to assist in the gathering of patienttransport equipment.

____ Establish ambulance off-loading area in cooperation with the Triage Unit Leader.____ Assemble gurneys, litters, wheelchairs and stretchers in proximity to ambulance off-

loading area and Triage Area.____ Establish ambulance loading area in cooperation with the Discharge Unit Leader.

Intermediate ____ Contact Safety & Security Officer on security needs of loading areas.____ Provide for the transportation/shipment of resources into and out of the facility.____ Secure ambulance or other transport for discharged patients.____ Identify transportation needs for ambulatory casualties.

Extended ____ Maintain transportation assignment record in Triage Area, Discharge Area, andMaterial Supply Pool.

____ Keep Logistics Section Chief apprised of status.____ Direct unassigned personnel to Labor Pool.____ Observe and assist any staff who exhibits signs of stress or fatigue. Report concerns

to Psychological Support Unit Leader. Provide for staff rest periods and relief.____ Other concerns:

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Job Action Sheet Materials Supply Unit Leader


MATERIALS SUPPLY UNIT LEADER




Mission: Organize and supply medical and non-medical care equipment and supplies.

Immediate ____ Receive appointment from Logistics Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Logistics Section Chief.____ Meet with and brief Materials Management and Central/Sterile Supply Personnel.____ Establish and communicate the operational status of the Materials Supply Pool to the

Logistics Section Chief, E.O.C. and Procurement Unit Leader.____ Dispatch the pre-designated supply carts to Triage Area, Immediate Treatment Area,

Delayed Treatment Area and the Minor Treatment Area, once these areas have beenestablished. Enlist the assistance of the Transportation Unit Leader.

____ Release Search and Rescue Team equipment packs to those teams designated by theDamage Assessment and Control Officer.

____ Collect and coordinate essential medical equipment and supplies. (Prepare to assistwith equipment salvage and recovery efforts.)

____ Develop medical equipment inventory to include, but not limited to the following:? Bandages, dressings, compresses and suture material? Sterile scrub brushes, normal saline, anti-microbial skin cleanser.? Waterless hand cleaner and gloves? Fracture immobilization, splinting and casting materials? Backboard, rigid stretchers? Non-rigid transporting devices (litters)? Oxygen-ventilation-suction devices? Advance life support equipment (chest tube, airway, major suture trays)

Extended ____ Identify additional equipment and supply needs. Make requests/needs known throughLogistics Section Chief. Gain the assistance of the Procurement Unit Leader whenindicated.

____ Determine the anticipated pharmaceuticals needed with the assistance of the MedicalCare Director and Pharmacy Unit Leader to obtain/request items.

____ Coordinate with Safety & Security Officer to protect resources.____ Observe and assist staff who exhibit signs of stress or fatigue. Report concerns to

Psychological Support Unit Leader.____ Other concerns:

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Job Action Sheet Nutritional Supply Unit Leader


NUTRITIONAL SUPPLY UNIT LEADER




Mission: Organize food and water stores for preparation and rationing during periods of anticipated oractual shortage.

Immediate ____ Receive appointment from Logistics Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Logistics Section Chief.____ Meet with and brief Nutritional Services personnel.____ Estimate the number of meals which can be served utilizing existing food stores;

implement rationing if situation dictates.____ Inventory the current emergency drinking water supply and estimate time when re-

supply will be necessary. Implement rationing if situation dictates.____ Report inventory levels of emergency drinking water and food stores to Logistics

Section Chief.Intermediate ____ Meet with Labor Pool Unit Leader and Staff Support Unit Leader to discuss location

of personnel refreshment and nutritional break areas.____ Secure nutritional and water inventories with the assistance of the Safety & Security

Officer.____ Submit an anticipated need list of water and food to the Logistics Section Chief.

Request should be based on current information concerning emergency events as wellas projected needs for patients, staff and dependents.

Extended ____ Meet with Logistics Section Chief regularly to keep informed of current status.____ Observe and assist staff who exhibit signs of stress and fatigue. Report concerns to

Psychological Support Unit Leader. Provide for staff rest period and relief.____ Other Concerns:

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM PLANING SECTION

Job Action Sheet Planning Section Chief


PLANNING SECTION CHIEF



Planning Command Center: Telephone:

Mission: Organize and direct all aspects of Planning Section operations. Ensure the distribution ofcritical information/data. Compile scenario/resource projections from all section chiefs andeffect long range planning. Document and distribute facility Action Plan.

Immediate ____ Receive appointment from Incident Commander. Obtain packet containing Section'sJob Action Sheets.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Incident Commander.____ Recruit a documentation aide from the Labor Pool____ Appoint Planning unit leaders: Situation - Status Unit Leader, Labor Pool Unit

Leader, Medical Staff Unit Leader, Nursing Unit Leader; distribute the correspondingJob Action Sheets and vests. (May be pre-established.)

____ Brief unit leaders after meeting with Emergency Incident Commander.____ Provide for a Planning/Information Center.____ Ensure the formulation and documentation of an incident-specific, facility Action Plan.

Distribute copies to Incident Commander and all section chiefs.____ Call for projection reports (Action Plan) from all Planning Section unit leaders and

section chiefs for scenarios 4, 8, 24 & 48 hours from time of incident onset. Adjusttime for receiving projection reports as necessary.

____ Instruct Situation - Status Unit Leader and staff to document/update status reportsfrom all disaster section chiefs and unit leaders for use in decision making and forreference in post-disaster evaluation and recovery assistance applications.

Intermediate ____ Obtain briefings and updates as appropriate. Continue to update and distribute thefacility Action Plan.

____ Schedule planning meetings to include Planning Section unit leaders, section chiefs andthe Incident Commander for continued update of the facility Action Plan.

Extended ____ Continue to receive projected activity reports from section chiefs and Planning Sectionunit leaders at appropriate intervals.

____ Assure that all requests are routed/documented through the Communications UnitLeader.



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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM PLANNING SECTION

Job Action Sheet Sit/Stat Unit Leader


SITUATION-STATUS (SIT-STAT) UNIT LEADER


You Report To: (Planning Section Chief)


Mission: Maintain current information regarding the incident status for all hospital staff. Ensure awritten record of the hospital's emergency planning and response. Develop the hospital'sinternal information network. Monitor the maintenance and preservation of the computersystem.

Immediate ____ Receive appointment from Planning Section Chief.____ Read this entire Job Action Sheet and review organizational chart back.____ Put on position identification vest.____ Obtain briefing from Planning Section Chief.____ Obtain status report on computer information system.____ Assign recorder to document decisions, actions and attendance in E.O.C.____ Establish a status/condition board in E.O.C. with a documentation aide. Ensure that

this board is kept current.____ Assign recorder to Communications Unit Leader to document telephone, radio and

memo traffic.Intermediate ____ Ensure that an adequate number of recorders are available to assist areas as needed.

Coordinate personnel with Labor Pool.____ Supervise backup and protection of existing data for main and support computer

systems.____ Publish an internal incident informational sheet for employee information at least every

4-6 hours. Enlist the assistance of the Public Information Officer, Staff Support UnitLeader and Labor Pool Unit Leader.

____ Ensure the security and prevent the loss of medical record hard copies.Extended ____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Labor Pool Unit Leader






Mission: Collect and inventory available staff and volunteers at a central point. Receive requests andassign available staff as needed. Maintain adequate numbers of both medical and non-medical personnel. Assist in the maintenance of staff morale.

Immediate ____ Receive appointment from Planning Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from the Planning Section Chief.____ Establish Labor Pool area and communicate operational status to E.O.C. and all

patient care and non-patient care areas.____ Inventory the number and classify staff presently available. Use the following

classifications and sub-classifications for personnel:

I. MEDICAL PERSONNEL

A. Physician (Obtain with assistance of Medical Staff Unit Leader.)

1. Critical Care2. General Care3. Other

B. Nurse

1. Critical Care2. General Care3. Other

C. Medical Technicians

1. Patient Care (aides, orderlies, EMTs, etc.)2. Diagnostic

II. NON-MEDICAL PERSONNEL

A. Engineering/Maintenance/Materials Management

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B. Environmental/Nutritional ServicesC. Business/FinancialD. VolunteerE. Other

____ Establish a registration and credentialing desk for volunteers not employed orassociated with the hospital.

____ Obtain assistance from Safety & Security Officer in the screening and identification ofvolunteer staff.

____ Meet with Nursing Unit Leader, Medical Staff Unit Leader and Operations SectionChief to coordinate long term staffing needs.

Intermediate ____ Maintain log of all assignments.____ Assist the Situation - Status Unit Leader in publishing an informational sheet to be

distributed at frequent intervals to update the hospital population.____ Maintain a message center in Labor Pool Area with the cooperation of Staff Support

Unit Leader and Situation - Status Information Systems Unit Leader.Extended ____ Brief Planning Section Chief as frequently as necessary on the status of labor pool

numbers and composition.____ Develop staff rest and nutritional area in coordination with Staff Support Unit Leader

and Nutritional Supply Unit Leader.____ Document actions and decisions on a continual basis.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Medical Staff Unit Leader


MEDICAL STAFF UNIT LEADER




Mission: Collect available physicians, and other medical staff, at a central point. Credential volunteermedical staff as necessary. Assist in the assignment of available medical staff as needed.

Immediate ____ Receive assignment from Planning Section Chief.____ Read this entire Job Action Sheet and refer to organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander or Planning Section Chief.____ Establish Medical Staff Pool in predetermined location and communicate operational

status to E.O.C. and Medical Staff Director. Obtain documentation personnel fromLabor Pool.

____ Inventory the number and types of physicians, and other staff present. Relayinformation to Labor Pool Unit Leader.

____ Register and credential volunteer physician/medical staff. Request the assistance ofthe Labor Pool Unit Leader and Safety & Security Officer when necessary.

Intermediate ____ Meet with Labor Pool Unit Leader, Nursing Service Unit Leader and OperationsSection Chief to coordinate projected staffing needs and issues.

____ Assist the Medical Staff Director in the assignment of medical staff to patient care andtreatment areas.

Extended ____ Establish a physician message center and emergency incident information board withthe assistance of Staff Support Unit Leader and Labor Pool Unit Leader.

____ Assist the Medical Staff Director in developing a medical staff rotation schedule.____ Assist the Medical Staff Director in maintaining a log of medical staff assignments.____ Brief Planning Section Chief as frequently as necessary on the status of medical staff

pool numbers and composition.____ Develop a medical staff rest and nutritional area in coordination with Staff Support

Unit Leader and the Nutritional Supply Unit Leader.____ Document actions and decisions on a continual basis.____ Observe and assist medical staff who exhibit signs of stress and other fatigue. Report

concerns to the Medical Staff Director and/or Psychological Support Unit Leader.____ Other concerns:

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Job Action Sheet Nursing Unit Leader


NURSING UNIT LEADER




Mission: Organize and coordinate nursing and direct patient care services.

Immediate ____ Receive appointment from Planning Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain a briefing from Emergency Incident Commander or Planning Section Chief.____ Appoint Patient Tracking Officer and Patient Information Officer and distribute the

corresponding Job Action Sheets. Ensure the implementation of a patient trackingsystem.

____ Obtain current in-patient census and request a prioritization assessment (triage) of allin-house patients from the Medical Care Director.

____ Meet with Operations Chief, Medical Staff Director and Medical Care Director toassess and project nursing staff and patient care supply needs.

____ Recall staff as appropriate; assist the Labor Pool in meeting the nursing staff needs ofthe Medical Care Director.

Intermediate ____ Implement emergency patient discharge plan at the direction of the Emergency IncidentCommander with support of the Medical Staff Director.

____ Meet regularly with the Patient Tracking Officer and Patient Information Officer.____ Meet with Labor Pool Unit Leader, Medical Care Director and Operations Section

Chief to coordinate long term staffing needs.____ Coordinate with the Labor Pool staff the number of nursing personnel which may be

released for future staffing or staffing at another facility.Extended ____ Establish a staff rest and nutritional area in cooperation with Labor Pool Unit Leader

and Staff Support Unit Leader.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Patient Tracking Officer




You Report To: (Nursing Unit Leader)


Mission: Maintain the location of patients at all times within the hospital's patient care system.

Immediate ____ Receive appointment from Nursing Unit Leader.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain a briefing from Nursing Unit Leader.____ Obtain patient census from Nursing Unit Leader, Admitting personnel or other source.____ Establish an area near the E.O.C. to track patient arrivals, location and disposition.

Obtain sufficient assistance to document current and accurate patient information.____ Ensure the proper use of the hospital disaster chart and tracking system for all newly

admitted.Intermediate ____ Meet with Patient Information Officer, Public Information Officer and Liaison Officer

on a routine basis to update and exchange patient information and census data.Extended ____ Maintain log to document the location and time of all patients cared for.



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Job Action Sheet Patient Information Officer


PATIENT INFORMATION OFFICER


You Report To: (Nursing Unit Leader)


Mission: Provide information to visitors and families regarding status and location of patients. Collectinformation necessary to complete the Disaster Welfare Inquiry process in cooperation withthe American Red Cross.

Immediate ____ Receive appointment from Nursing Unit Leader.____ Read this entire Job Action Sheet and review organizational chart back.____ Put on position identification vest.____ Obtain briefing on incident and any special instructions from Nursing Unit Leader.____ Establish Patient Information Area away from E.O.C.____ Meet with Patient Tracking Officer to exchange patient related information and

establish regularly scheduled meetings.Intermediate ____ Direct patient related news releases through Nursing Unit Leader to the Public

Information Officer.____ Receive and screen requests about the status of individual patients. Obtain appropriate

information and relay to the appropriate requesting party.____ Request assistance of runners and amateur radio operators from Labor Pool as needed.

Extended ____ Work with American Red Cross representative in development of the Disaster WelfareInquiry information.



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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM FINANCE SECTION

Job Action Sheet Finance Section Chief


FINANCE SECTION CHIEF



Finance Command Center: Telephone:

Mission: Monitor the utilization of financial assets. Oversee the acquisition of supplies and servicesnecessary to carry out the hospital's medical mission. Supervise the documentation ofexpenditures relevant to the emergency incident.

Immediate ____ Receive appointment from Emergency Incident Commander. Obtain packet containingSection's Job Action Sheets.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander.____ Appoint Time Unit Leader, Procurement Unit Leader, Claims Unit Leader and Cost

Unit Leader; distribute the corresponding Job Action Sheets and vests. (May be pre-established.)

____ Confer with Unit Leaders after meeting with Emergency Incident Commander; developa section action plan.

____ Establish a Financial Section Operations Center. Ensure adequatedocumentation/recording personnel.

Intermediate ____ Approve a "cost-to-date" incident financial status report submitted by the Cost UnitLeader every eight hours summarizing financial data relative to personnel, suppliesand miscellaneous expenses.

____ Obtain briefings and updates from Emergency Incident Commander as appropriate.Relate pertinent financial status reports to appropriate chiefs and unit leaders.

____ Schedule planning meetings to include Finance Section unit leaders to discuss updatingthe section's incident action plan and termination procedures.

Extended ____ Assure that all requests for personnel or supplies are copied to the CommunicationsUnit Leader in a timely manner.



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Job Action Sheet Time Unit Leader


TIME UNIT LEADER


You Report To: (Finance Section Chief).


Mission: Responsible for the documentation of personnel time records. The monitoring and reportingof regular and overtime hours worked/volunteered.

Immediate ____ Receive appointment from Finance Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Finance Section Chief; assist in the development of the section

action plan.____ Ensure the documentation of personnel hours worked and volunteer hours worked in

all areas relevant to the hospital's emergency incident response. Confirm the utilizationof the Emergency Incident Time Sheet by all section chiefs and/or unit leaders.Coordinate with Labor Pool Unit Leader.

Intermediate ____ Collect all Emergency Incident Time Sheets from each work area for recording andtabulation every eight hours, or as specified by the Finance Section Chief.

____ Forward tabulated Emergency Incident Time Sheets to Cost Unit Leader every eighthours.

Extended ____ Prepare a total of personnel hours worked during the declared emergency incident.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Procurement Unit Leader


PROCUREMENT UNIT LEADER


You Report To: (Finance Section Chief)


Mission: Responsible for administering accounts receivable and payable to contract and non-contractvendors.

Immediate ____ Receive appointment from Finance Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Finance Section Chief; assist in the development of the section

action plan.____ Ensure the separate accounting of all contracts specifically related to the emergency

incident; and all purchases within the enactment of the emergency incident responseplan.

____ Establish a line of communication with the Material Supply Unit Leader.____ Obtain authorization to initiate purchases from the Finance Section Chief, or

authorized representative.Intermediate ____ Forward a summary accounting of purchases to the Cost Unit Leader every eight

hours.Extended ____ Prepare a Procurement Summary Report identifying all contracts initiated during the

declared emergency incident.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Claims Officer


CLAIMS UNIT LEADER




Mission: Responsible for receiving, investigating and documenting all claims reported to the hospitalduring the emergency incident which are alleged to be the result of an accident or action onhospital property.

Immediate ____ Receive appointment from Finance Section Chief.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Finance Section Chief; assist in the development of section action

plan.____ Receive and document alleged claims issued by employees and non-employees. Use

photographs or video documentation when appropriate.____ Obtain statements as quickly as possible from all claimants and witnesses.____ Enlist the assistance of the Safety & Security Officer where necessary.

Intermediate ____ Inform Finance Section Chief of all alleged claims as they are reported.____ Document claims on hospital risk/loss forms.

Extended ____ Report any cost incurred as a result of a claim to the Cost Unit Leader as soon aspossible.

____ Prepare a summary of all claims reported during the declared emergency incident.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet Cost Unit Leader


COST UNIT LEADER




Mission: Responsible for providing cost analysis data for declared emergency incident. Maintenance ofaccurate records of incident cost.

Immediate ____ Receive appointment from Finance Section Chief.____ Read this entire Job Action Sheet and review the Organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Finance Section Chief; assist in development of section action

plan.____ Meet with Time Unit Leader, Procurement Unit Leader and Claims Unit Leader to

establish schedule for routine reporting periods.Intermediate ____ Prepare a "cost-to-date" report form for submission to Finance Section Chief once

every eight hours.____ Inform all section chief's of pertinent cost data at the direction of the Finance Section

Chief or Emergency Incident Commander.Extended ____ Prepare a summary of all costs incurred during the declared emergency incident.



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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM OPERATIONS SECTION

Job Action Sheet Operations Section Chief


OPERATIONS SECTION CHIEF



Operations Command Center: Telephone:

Mission: Organize and direct aspects relating to the Operations Section. Carry out directives of theEmergency Incident Commander. Coordinate and supervise the Medical Services Subsection,Ancillary Services Subsection and Human Services Subsection of the Operations Section.

Immediate ____ Receive appointment from Emergency Incident Commander. Obtain packet containingSection's Job Action Sheets.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Emergency Incident Commander.____ Appoint Medical Staff Director, Medical Care Director, Ancillary Services Director

and Human Services Director and transfer the corresponding Job Action Sheets. (Maybe pre-established.)

____ Brief all Operations Section directors on current situation and develop the section'sinitial action plan. Designate time for next briefing.

____ Establish Operations Section Center in proximity to E.O.C.____ Meet with the Medical Staff Director, Medical Care Director and Nursing Unit Leader

to plan and project patient care needs.Intermediate ____ Designate times for briefings and updates with all Operations Section directors to

develop/update section's action plan.____ Ensure that the Medical Services Subsection, Ancillary Services Subsection and

Human Services Subsection are adequately staffed and supplied.____ Brief the Emergency Incident Commander routinely on the status of the Operations

Section.Extended ____ Assure that all communications are copied to the Communications Unit Leader;

document all actions and decisions.____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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Job Action Sheet MEDICAL SERVICES SUBSECTION

Medical Staff Director


MEDICAL STAFF DIRECTOR


You Report To: (Operations Section Chief)


Mission: Organize, prioritize and assign physicians to areas where medical care is being delivered.Advise the Incident Commander on issues related to the Medical Staff.

Immediate ____ Receive appointment from the Operations Section Chief.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Meet with Operations Section Chief and other Operations Section directors for briefing

and development of an initial action plan.____ Meet with the Medical Staff Unit Leader to facilitate recruitment and staffing of

Medical Staff. Assist in Medical Staff credentialing issues.____ Document all physician assignments; facilitate rotation of physician staff with the

assistance of the Medical Staff Unit Leader; where necessary, assist with physicianorientation to in-patient and treatment areas.

____ Meet with Operations Chief, Medical Care Director and Nursing Unit Leader to planand project patient care needs.

____ Provide medical staff support for patient priority assessment to designate patients forearly discharge.

Intermediate ____ Meet with Incident Commander for appraisal of the situation regarding medical staffand projected needs. Establish meeting schedule with IC if necessary.

____ Maintain communication with the Medical Care Director to co-monitor the deliveryand quality of medical care in all patient care areas.

Extended ____ Ensure maintenance of Medical Staff time sheet; obtain clerical support from LaborPool if necessary.

____ Meet as often as necessary with the Operations Section Chief to keep appraised ofcurrent conditions.



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Medical Care Director


MEDICAL CARE DIRECTOR




Mission: Organize and direct the overall delivery of medical care in all areas of the hospital.

Immediate ____ Receive appointment from the Operations Section Chief and receive the Job ActionSheets for the Medical Services Subsection.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Meet with Operations Section Chief and other Operations Section directors for briefing

and development of an initial action plan. Establish time for follow up meetings.____ Appoint the In-Patient Areas Supervisor and the Treatment Areas Supervisor and

transfer the corresponding Job Action Sheets.____ Assist in establishing an Operations Section Center in proximity to the E.O.C.____ Meet with In-Patient Areas Supervisor and Treatment Areas Supervisor to discuss

medical care needs and physician staffing in all patient care areas.____ Confer with the Operations Chief, Medical Staff Director and Nursing Unit Leader to

make medical staff and nursing staffing/material needs known.____ Request Medical Staff Director to provide medical staff support to assist with patient

priority assessment to designate those eligible for early discharge.____ Establish 2-way communication (radio or runner) with In-Patient Areas Supervisor

and Treatment Areas Supervisor.Intermediate ____ Meet regularly with Medical Staff Director, In-Patient Areas Supervisor and

Treatment Areas Supervisor to assess current and project future patient careconditions.

____ Brief Operations Section Chief routinely on the status/quality of medical care.Extended ____ Observe all staff, volunteers and patients for signs of stress and inappropriate



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In-Patient Areas Supervisor


IN-PATIENT AREAS SUPERVISOR


You Report To: (Medical Care Director)


Mission: Assure treatment of in-patients and manage the in-patient care area(s). Provide for acontrolled patient discharge.

Immediate ____ Receive appointment from Medical Care Director and receive Job Action Sheets forthe Surgical Services, Maternal - Child, Critical Care, General Nursing and OutPatient Services Unit Leaders.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Medical Care Director; develop initial action plan with Medical

Care Director, Treatment Areas Supervisor and Medical Staff Director.____ Appoint Unit Leaders for:

? Surgical Services? Maternal - Child? Critical Care? General Nursing Care? Out Patient Services

____ Distribute corresponding Job Action Sheets, request a documentation aide/assistant foreach unit leader from Labor Pool.

____ Brief unit leaders on current status. Designate time for follow-up meeting.____ Assist establishment of in-patient care areas in new locations if necessary.____ Instruct all unit leaders to begin patient priority assessment; designate those eligible for

early discharge. Remind all unit leaders that all in-patient discharges are routedthrough the Discharge Unit.

____ Assess problems and treatment needs in each area; coordinate the staffing and suppliesbetween each area to meet needs.

____ Meet with Medical Care Director to discuss medical care plan of action and staffing inall in-patient care areas.

____ Receive, coordinate and forward requests for personnel and supplies to the Labor PoolUnit Leader, Medical Care Director and Material Supply Unit Leader. Copy allcommunication to the Communications Unit Leader.

Intermediate ____ Contact the Safety & Security Officer for any security needs. Advise the MedicalCare Director of any actions/requests.

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____ Report equipment needs to Materials Supply Unit Leader.____ Establish 2-way communication (radio or runner) with Medical Care Director.____ Assess environmental services (housekeeping) needs in all in-patient care areas;

contact Sanitation Systems Officer for assistance.Extended ____ Assist Patient Tracking Officer and Patient Information Officer in obtaining

information.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report any

concerns to Psychological Support Unit Leader. Provide for staff rest periods andrelief.

____ Report frequently and routinely to Medical Care Director to keep apprised of situation.____ Document all action/decisions with a copy sent to the Medical Care Director.____ Other concerns:

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Job Action Sheet MEDICAL SERVICE SUBSECTION

Surgical Services Unit

Revised :5-93 Reviewed: 6-98

SURGICAL SERVICES UNIT LEADER


You Report To: (In-Patient Areas Supervisor)


Mission: Supervise and maintain the surgical capabilities to the best possible level in respect to currentconditions in order to meet the needs of in-house and newly admitted patients.

Immediate ____ Receive appointment from In-Patient Areas Supervisor.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from In-Patient Areas Supervisor with other In-Patient Area unit

leaders.____ Assess current pre-op, operating suite and post-op capabilities. Project immediate and

prolonged capacities to provide surgical services based on current data.____ Begin patient priority assessment; designate those eligible for early discharge. Remind

all staff that all in-patient discharges are routed through the Discharge Unit.____ Develop action plan in cooperation with other In-Patient Area unit leaders and the In-

Patient Areas Supervisor____ Request needed resources from the In-Patient Areas Supervisor.____ Assign and schedule O.R. teams as necessary; obtain additional personnel from Labor

Pool.Intermediate ____ Identify location of Immediate and Delayed Treatment areas; inform patient

transportation personnel.____ Contact Safety & Security Officer of security and traffic flow needs in the Surgical

Services area. Inform In-Patient Areas Supervisor of action.____ Report equipment/material needs to Materials Supply Unit Leader. Inform In-Patient

Areas Supervisor of action.Extended ____ Ensure that all area and individual documentation is current and accurate. Request

documentation/clerical personnel from Labor Pool if necessary.____ Keep In-Patient Areas Supervisor, Immediate Treatment and Delayed Treatment Unit

Leader apprised of status, capabilities and projected services.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to In-Patient Areas Supervisor. Provide for staff rest periods and relief.____ Review and approve the area documentation aide's recordings of actions/decisions in

the Surgical Services Area. Send copy to the In-Patient Areas Supervisor.____ Direct non-utilized personnel to Labor Pool.____ Other concerns:

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Maternal Child Unit Leader


MATERNAL-CHILD UNIT LEADER




Mission: Supervise and maintain the obstetrical, labor & delivery, nursery, and pediatric services to thebest possible level in respect to current conditions in order to meet the needs of in-house andnewly admitted patients.


leaders.____ Assess current capabilities. Project immediate and prolonged capacities to provide all

obstetrical and pediatric services based on current capabilities. (Give specialconsideration to the possibility of an increase in normal and premature deliveries due toenvironmental/emotional stress.)

____ Begin patient priority assessment; designate those eligible for early discharge. Remindall staff that all in-patient discharges are routed through the Discharge Unit.

____ Develop action plan in cooperation with other In-Patient Area unit leaders and the In-Patient Areas Supervisor.

____ Request needed resources from the In-Patient Areas Supervisor.____ Assign delivery and patient teams as necessary; obtain additional personnel from

Labor Pool.Intermediate ____ Identify location of Immediate and Delayed Treatment areas; inform patient

transportation personnel.____ Contact Safety & Security Officer of security and traffic flow needs. Inform In-

Patient Areas Supervisor of action.____ Report equipment/material needs to Materials Supply Unit Leader. Inform In-Patient


documentation/clerical personnel from Labor Pool if necessary.____ Keep In-Patient Areas Supervisor, Immediate Treatment and Delayed Treatment Unit

Leader apprised of status, capabilities and projected services.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to In-Patient Areas Supervisor. Provide for staff rest periods and relief.____ Review and approve the area documentation aide's recordings of actions/decisions in

the Surgical Services Area. Send copy to the In-Patient Areas Supervisor.

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____ Direct non-utilized personnel to Labor Pool.____ Other concerns:

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Critical Care Unit Leader


CRITICAL CARE UNIT LEADER




Mission: Supervise and maintain the critical care capabilities to the best possible level to meet the needsof in-house and newly admitted patients.

Immediate ____ Receive appointment from In-Patient Areas Supervisor. ____ Read this entire Job Action Sheet and review organizational chart on back. ____ Put on position identification vest. ____ Receive briefing from In-Patient Areas Supervisor with other In-Patient Area unit

leaders. ____ Assess current critical care patient capabilities. Project immediate and prolonged

capabilities to provide services based on known resources. Obtain medical staffsupport to make patient triage decisions if warranted.

____ Develop action plan in cooperation with other In-Patient Area unit leaders and the In-Patient Areas Supervisor

____ Request the assistance of the In-Patient Areas Supervisor to obtain resources ifnecessary.

____ Assign patient care teams as necessary; obtain additional personnel from Labor Pool.Intermediate ____ Identify location of Discharge Area; inform patient transportation personnel.

____ Contact Safety & Security Officer of security and traffic flow needs in the critical careservices area(s). Inform In-Patient Areas Supervisor of action.

____ Report equipment/material needs to Materials Supply Unit Leader. Inform In-PatientAreas Supervisor of action.

Extended ____ Ensure that all area and individual documentation is current and accurate. Requestdocumentation/ clerical personnel from Labor Pool if necessary.

____ Keep In-Patient Areas Supervisor, Immediate Treatment and Delayed Treatment UnitLeaders apprised of status, capabilities and projected services.

____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concernsto In-Patient Areas Supervisor. Provide for staff rest periods and relief.

____ Review and approve the area document’s recordings of actions/decisions in the CriticalCare Area(s). Send copy to the In-Patient Areas Supervisor.


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General Nursing Care Unit Leader


GENERAL NURSING CARE UNIT LEADER




Mission: Supervise and maintain general nursing services to the best possible level to meet the needs ofin-house and newly admitted patients.


leaders.____ Assess current capabilities. Project immediate and prolonged capacities to provide

general medical/ surgical nursing services based on current data.____ Begin patient priority assessment; designate those eligible for early discharge. Remind

all staff that all in-patient discharges are routed through the Discharge Unit.____ Develop action plan in cooperation with other In-Patient Area unit leaders and the In-

Patient Areas Supervisor.____ Request needed resources from the In-Patient Areas Supervisor.____ Assign patient care teams as necessary; obtain additional personnel from Labor Pool.

Intermediate ____ Identify location of Immediate and Delayed Treatment areas; inform patienttransportation personnel.

____ Contact Safety & Security Officer of security and traffic flow needs. Inform In-Patient Areas Supervisor of action.

____ Report equipment/material needs to Materials Supply Unit Leader. Inform In-PatientAreas Supervisor of action.

Extended ____ Ensure that all area and individual documentation is current and adhered. Requestdocumentation/clerical personnel from Labor Pool if necessary.

____ Keep In-Patient Areas Supervisor, Immediate Treatment and Delayed Treatment UnitLeader apprised of status, capabilities and projected services.

____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concernsto In-Patient Areas Supervisor. Provide for staff rest periods and relief.

____ Review and approve the area documenter's recordings of actions/decisions in theSurgical Services Area. Send copy to the In-Patient Areas Supervisor.


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Outpatient Services Unit Leader


OUT PATIENT SERVICES UNIT LEADER




Mission: Prepare any out patient service areas to meet the needs of in-house and newly admittedpatients.


leaders.____ Assess current capabilities. Project immediate and prolonged capacities to provide

nursing services based on current data.____ Begin out patient priority assessment; designate those eligible for immediate discharge;

admit those patients unable to be discharged. Remind all staff that all patientdischarges are routed through the Discharge Unit.

____ Develop action plan in cooperation with other In-Patient Area unit leaders and the In-Patient Areas Supervisor.

____ Request needed resources from the In-Patient Areas Supervisor.____ Assign patient care teams in configurations to meet the specific mission of the Out

Patient areas; obtain additional personnel as necessary from Labor Pool.Intermediate ____ Contact Safety & Security Officer of security and traffic flow needs. Inform In-

Patient Areas Supervisor of action.____ Report equipment/material needs to Materials Supply Unit Leader. Inform In-Patient


documentation/clerical personnel from Labor Pool if necessary.____ Keep In-Patient Areas Supervisor apprised of status, capabilities and projected

services.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to In-Patient Areas Supervisor. Provide for staff rest periods and relief.____ Review and approve the area documenter's recordings of actions/decisions in the

Surgical Services Area. Send copy to the In-Patient Areas Supervisor.____ Direct non-utilized personnel to Labor Pool.____ Other concerns:

2 - 44



Treatment Areas Supervisor


TREATMENT AREAS SUPERVISOR


You Report To: (Medical Care Director)


Mission: Initiate and supervise the patient triage process. Assure treatment of casualties according totriage categories and manage the treatment area(s). Provide for a controlled patient discharge.Supervise morgue service.

Immediate ____ Receive appointment from Medical Care Director and Job Action Sheets for theTriage, Immediate-Delayed-Minor Treatment, Discharge and Morgue Unit Leaders.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Medical Care Director and develop initial action plan with

Medical Care Director, In-Patient Areas Supervisor and Medical Staff Director.____ Appoint unit leaders for the following treatment areas:

? Triage? Immediate Treatment? Delayed Treatment? Minor Treatment? Discharge? Morgue

Distribute corresponding Job Action Sheets, request a documentation aide/assistant foreach unit leader from Labor Pool.

____ Brief Treatment Area unit leaders. Designate time for follow-up meeting.____ Assist establishment of Triage, Immediate, Delayed, Minor Treatment, Discharge and

Morgue Areas in pre-established locations.____ Assess problem, treatment needs and customize the staffing and supplies in each area.____ Meet with Medical Care Director to discuss medical care plan of action and staffing in

all triage/treatment/discharge/morgue areas. Maintain awareness of all in-patientcapabilities, especially surgical services via the In-Patient Areas Supervisor.

____ Receive, coordinate and forward requests for personnel and supplies to the Labor PoolUnit Leader, Medical Care Director and Material Supply Unit Leader. Copy allcommunication to the Communications Unit Leader.

Intermediate ____ Contact the Safety and Security Officer for any security needs, especially those in theTriage, Discharge and Morgue areas. Advise the Medical Care Director of anyactions/requests.

2 - 45

____ Report equipment needs to Materials Supply Unit Leader.____ Establish 2-way communication (radio or runner) with Medical Care Director.____ Assess environmental services (housekeeping) needs for all Treatment Areas; contact

Sanitation Systems Officer for assistance.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report any


____ Assist Patient Tracking Officer and Patient Information Officer in obtaininginformation.

Extended ____ Report frequently and routinely to Medical Care Director to keep apprised of situation.____ Document all action/decisions with a copy sent to the Medical Care Director.____ Other concerns:

2 - 46



Triage Unit Leader


TRIAGE UNIT LEADER


You Report To: (Treatment Areas Supervisor)


Mission: Sort casualties according to priority of injuries, and assure their disposition to the propertreatment area.

Immediate ____ Receive appointment from Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Area unit

leaders.____ Establish patient Triage Area; consult with Transportation Unit Leader to designate

the ambulance off-loading area.____ Ensure sufficient transport equipment and personnel for Triage Area.____ Assess problem, triage-treatment needs relative to specific incident.____ Assist the In-Patient Areas Supervisor with triage of internal hospital patients, if

requested by Treatment Areas Supervisor.____ Develop action plan, request needed resources from Treatment Areas Supervisor.____ Assign triage teams.

Intermediate ____ Identify location of Immediate, Delayed, Minor Treatment, Discharge and Morgueareas; coordinate with Treatment Areas Supervisor.

____ Contact Safety & Security Officer of security and traffic flow needs in the TriageArea. Inform Treatment Areas Supervisor of action.

Extended ____ Report emergency care equipment needs to Materials Supply Unit Leader. InformTreatment Areas Supervisor of action.

____ Ensure that the disaster chart and admission forms are utilized. Requestdocumentation/clerical personnel from Labor Pool if necessary.

____ Keep Treatment Areas Supervisor apprised of status, number of injured in the TriageArea or expected to arrive there.

____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concernsto Treatment Areas Supervisor. Provide for staff rest periods and relief.

____ Review and approve the area documenter's recordings of actions/decisions in theTriage Area. Send copy to the Treatment Areas Supervisor.


2 - 47



Immediate Treatment Unit Leader


IMMEDIATE TREATMENT UNIT LEADER




Mission: Coordinate the care given to patients received from the Triage Area; assure adequate staffingand supplies in the Immediate Treatment Area; facilitate the treatment and disposition ofpatients in the Immediate Treatment Area.

Immediate ____ Receive appointment from Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Area unit

leaders.____ Assist Treatment Areas Unit Leader in the establishment of Immediate Treatment

Area.____ Assess situation/area for supply and staffing needs; request staff and supplies from the

Labor Pool and Materials Supply Unit Leaders. Request medical staff support throughTreatment Areas Supervisor.

____ Obtain an adequate number of patient transportation resources from theTransportation Unit Leader to ensure the movement of patients in and out of the area.

Intermediate ____ Ensure the rapid disposition and flow of treated patients from the Immediate TreatmentArea.

____ Report frequently and routinely to the Treatment Areas Supervisor on situationalstatus.

Extended ____ Observe and assist any staff who exhibits signs of stress and fatigue. Report anyconcerns to the Treatment Areas Unit Leader. Provide for staff rest periods and relief.

____ Review and approve the area documenter's recordings of actions/decisions in theImmediate Treatment Area. Send copy to the Treatment Areas Supervisor.


2 - 48



Delayed Treatment Unit Leader


DELAYED TREATMENT UNIT LEADER




Mission: Coordinate the care given to patients received from the Triage Area. Assure adequate staffingand supplies in the Delayed Treatment Area. Facilitate the treatment and disposition ofpatients in the Delayed Treatment Area.

Immediate ____ Receive appointment from Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Area unit

leaders.____ Assist Treatment Areas Supervisor in the establishment of Delayed Treatment Area.____ Assess situation/area for supply and staffing need; request staff and supplies from the


____ Obtain an adequate number of patient transportation resources from theTransportation Unit Leader to ensure the movement of patients in and out of area.

Intermediate ____ Ensure the rapid disposition and flow of treated patients from the Delayed TreatmentArea.


Extended ____ Observe and assist any staff who exhibits signs of stress and fatigue. Report anyconcerns to the Treatment Areas Supervisor. Provide for staff rest periods and relief.

____ Review and approve the area documenter's recordings of actions/decisions in theDelayed Treatment Area. Send copy to the Treatment Areas Supervisor.


2 - 49



Minor Treatment Unit Leader


MINOR TREATMENT UNIT LEADER




Mission: Coordinate the minor care of patients received from the Triage Area, and other areas of thehospital. Assure adequate staffing and supplies in the Minor Treatment. Facilitate the minortreatment of patients and disposition.

Immediate ____ Receive appointment from the Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Area unit

leaders.____ Assist Treatment Areas Supervisor in the establishment of Minor Treatment Area.____ Assess situation/area for supply and staffing need; request staff and supplies from the


Intermediate ____ Obtain an adequate number of patient transportation resources from theTransportation Unit Leader to ensure the movement of patients in and out of the area.

____ Ensure a rapid, appropriate disposition of patients treated within Minor TreatmentArea.


Extended ____ Observe and assist any staff who exhibit signs of stress or fatigue. Report anyconcerns to the Treatment Areas Supervisor. Provide for staff rest periods and relief.

____ Review and approve the area documenter's recordings of action/decisions in the MinorTreatment Area. Send copy to the Treatment Areas Supervisor.


2 - 50



Discharge Unit Leader


DISCHARGE UNIT LEADER




Mission: Coordinate the controlled discharge, (possible observation and discharge) of patients receivedfrom all areas of the hospital. Facilitate the process of final patient disposition by assuringadequate staff and supplies in the Discharge Area.

Immediate ____ Receive appointment from the Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Areas unit

leaders.____ Assist Treatment Areas Supervisor in the establishment of Discharge Area.

Coordinate with Human Services Director, Transportation Unit Leader and Safety &Security Officer.

____ Assess situation/area for supply and staffing need; request staff and supplies from theLabor Pool and Materials Supply Unit Leaders. Request medical staff support throughTreatment Areas Supervisor. Prepare area for minor medical treatment and extendedobservation.

Intermediate ____ Request involvement of Human Services Director in appropriate patient disposition.Communicate regularly with Patient Tracking Officer.

____ Ensure that all patients discharged from area are tracked and documented in regards todisposition. Ensure a copy of the patient chart is sent with patient transfers. If copyservice is not available, record chart number and destination for future retrieval. (Ifother hospital areas are discharging patients, provide for accurate controls anddocumentation.) Provide for patient discharge services in Morgue Area.

____ Report frequently and routinely to Treatment Areas Supervisor on situational status.Extended ____ Observe and assist any staff or patient who exhibits sign of stress. Report concerns to

the Treatment Areas Supervisor. Provide for staff rest periods and relief.____ Review and approve the area documenter's recordings of action/decisions in the

Discharge Area. Send copy to the Treatment Areas Supervisor.____ Direct non-utilized personnel to Labor Pool.____ Other concerns:

2 - 51

HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM OPERATION SECTION


Morgue Unit Leader


MORGUE UNIT LEADER




Mission: Collect, protect and identify deceased patients. Assist Discharge Area Unit Leader inappropriate patient discharge.

Immediate ____ Receive appointment from the Treatment Areas Supervisor.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Treatment Areas Supervisor with other Treatment Area unit

leaders.____ Establish Morgue Area; coordinate with Treatment Areas Supervisor and Medical

Care Director.____ Request an on-call physician from the Treatment Areas Supervisor to confirm any

resuscitatable casualties in Morgue Area.____ Obtain assistance from the Transportation Unit Leader for transporting deceased

patients.____ Assure all transporting devices are removed from under deceased patients and returned

to the Triage Area.Extended ____ Maintain master list of deceased patients with time of arrival for Patient Tracking

Officer and Patient Information Officer.____ Assure all personal belongings are kept with deceased patients and are secured.____ Assure all deceased patients in Morgue Areas are covered, tagged and identified where

possible.____ Keep Treatment Areas unit leaders apprised of number of deceased.____ Contact the Safety & Security Officer for any morgue security needs.____ Arrange for frequent rest and recovery periods, as well as relief for staff.____ Schedule meetings with the Psychological Support Unit Leader to allow for staff

debriefing.____ Observe and assist any staff who exhibits signs of stress or fatigue. Report any

concerns to the Treatment Areas Supervisor.____ Review and approve the area documenter's recording of action/decisions in the Morgue

Area. Send copy to the Treatment Areas Supervisor.____ Direct non-utilized personnel to Labor Pool.____ Other concerns:

2 - 52


Job Action Sheet ANCILLARY SERVICES SUBSECTION

Ancillary Services Director


ANCILLARY SERVICES DIRECTOR




Mission: Organize and manage ancillary medical services. To assist in providing for the optimalfunctioning of these services. Monitor the use and conservation of these resources.

Immediate ____ Receive appointment from Operation Section Chief and subsection's Job ActionSheets.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Meet with Operations Section Chief and other Operations Section directors for a

briefing and development of initial action plan. Designate time for next meeting.____ Appoint unit leaders for:

? Laboratory Services? Radiology Services? Pharmacy Services? Cardiopulmonary Services

Distribute corresponding Job Action Sheets; request a documentation aide/assistant foreach unit leader from the Labor Pool.

____ Brief all unit leaders. Request an immediate assessment of each service's capabilities,human resources and needs. Designate time for follow-up meeting.

____ Receive, coordinate and forward requests for personnel and materials to theappropriate individual.

Intermediate ____ Report routinely to the Operations Section Chief the actions, decisions and needs of theAncillary Services Section.

____ Track the ordering and receiving of needed supplies.____ Supervise salvage operations within Ancillary Services when indicated.____ Meet routinely with Ancillary Services unit leaders for status reports, and relay

important information to Operation Section Chief.Extended ____ Observe and assist any staff who exhibits signs of stress or fatigue. Report any


____ Review and approve the documenter's recordings of actions/decisions in the AncillaryServices Section. Send copy to the Operations Section Chief.


2 - 53



Laboratory Unit Leader


LABORATORY UNIT LEADER


You Report To: (Ancillary Services Director)


Mission: Maintain Laboratory services, blood and blood products at appropriate levels. Prioritize andmanage the activity of the Laboratory Staff.

Immediate ____ Receive appointment from Ancillary Services Director.____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Receive briefing from Ancillary Services Director with other subsection unit leaders;

develop a subsection action plan.____ Inventory available blood supply and designate those units of blood, if any, which may

be released for use outside the facility. Report information to Ancillary ServicesDirector and Communications Unit Leader.

____ Evaluate Laboratory Service's capacity to perform:

? Hematology studies? Chemistry studies? Blood Bank services

____ Ascertain the approximate "turn around" time for study results. Report capabilitiesand operational readiness to Ancillary Services Director.

____ Assign a phlebotomies and runner with adequate blood collection supplies to theImmediate Treatment and Delayed Treatment Areas.

Intermediate ____ Contact Materials Supply Unit Leader in anticipation of needed supplies.____ Prepare for the possibility of initiating blood donor services.____ Send any unassigned personnel to Labor Pool.____ Inform patient care areas of currently available service.____ Communicate with Patient Tracking Officer to ensure accurate routing of test results.

Extended ____ Provide for routine meetings with Ancillary Services Director.____ Review and approve the documenter's recordings of actions/decisions in the

Laboratory Services area. Send copy of to the Ancillary Services Director.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to Ancillary Services Director. Provide for staff rest periods and relief.____ Other concerns:

2 - 54



Radiology Unit Leader


RADIOLOGY UNIT LEADER




Mission: Maintain radiology and other diagnostic imaging services at appropriate levels. Ensure thehighest quality of service under current conditions.

Immediate ____ Receive appointment from Ancillary Services Director.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Ancillary Services Director with other subsection unit leaders;

develop a subsection action plan.____ Evaluate Radiology Service's capacity to perform x-ray and other appropriate

procedures:? Number of Operational X-ray suites? Number of operational portable X-ray units? Number of hours of film processing available? Availability of CT scan or MRI? Availability of fluoroscopy

Report status to Ancillary Services Director.____ Provide radiology technician and portable X-ray unit to Immediate and Delayed

Treatment Areas, if available.Intermediate ____ Contact Materials Supply Unit Leader in anticipation of needed supplies.

____ Send any unassigned personnel to Labor Pool.____ Inform patient care areas of currently available radiology services.____ Communicate with Patient Tracking Officer to ensure accurate routing of test results.

Extended ____ Provide for routine meetings with Ancillary Services Director.____ Review and approve the documenter's recordings of action/decisions in the Radiology

Services Area. Send copy to Ancillary Services Director.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report concerns

to Ancillary Services Director. Provide for staff rest periods and relief.____ Other concerns:

2 - 55



Pharmacy Unit Leader


PHARMACY UNIT LEADER




Mission: Ensure the availability of emergency, incident specific, pharmaceutical and pharmacyservices.


develop a subsection action plan.____ Assign pharmacist to Immediate and Delayed Treatment Areas, when appropriate.____ Inventory most commonly utilized pharmaceutical items and provide for the continual

update of this inventory.____ Identify any inventories which might be transferred upon request to another facility and

communicate list to the Ancillary Services Director.Intermediate ____ Communicate with the Materials Supply Unit Leader to assure a smooth method of

requisitioning and delivery of pharmaceutical inventories within the hospital.Extended ____ Provide for routine meetings with Ancillary Services Director.

____ Review and approve the documenter's recordings of actions/decisions in the PharmacyService Area. Send copy to Ancillary Services Director.

____ Observe and assist any staff who exhibit signs of stress and fatigue. Report anyconcerns to Ancillary Services Director. Provide for staff rest periods and relief.


2 - 56



Cardiopulmonary Unit Leader


CARDIOPULMONARY UNIT LEADER




Mission: Provide the highest level of Cardiopulmonary services at levels sufficient to meet theemergency incident needs.


develop a subsection action plan.____ Evaluate Cardiopulmonary service's capacity to supply/perform:

? Operational ventilatory equipment? Arterial blood gas analysis (ABG's)? Electrocardiograph study (EKG)? In-wall oxygen, nitrous oxide and other medical gases (confer with Damage

Assessment and Control Officer)? Size and availability of gas cylinders

Report status/information of Ancillary Services Director.____ Assign respiratory therapist technician and EKG technician to the Immediate

Treatment Area, when appropriate.Intermediate ____ Consider the possibility of requesting additional Cardiopulmonary resources vs.

developing a list of resources which may be loaned out of the facility.Extended ____ Monitor levels of all medical gases.

____ Provide for routine meetings with Ancillary Services Director.____ Review and approve the documenter's recordings of actions/decisions in the

Cardiopulmonary Services area. Send copy to the Ancillary Services Director.____ Observe and assist any staff who exhibit signs of stress and fatigue. Report any

concerns to Ancillary Services Director. Provide for staff rest periods and relief.____ Other concerns:

2 - 57


Job Action Sheet HUMAN SERVICES SUBSECTION

Human Services Director


HUMAN SERVICES DIRECTOR




Mission: Organize, direct and supervise those services associated with the social and psychologicalneeds of the patients, staff and their respective families. Assist with discharge planning.

Immediate ____ Receive appointment from Operations Section Chief. Obtain packet containingsubsection Job Action Sheets.

____ Read this entire Job Action Sheet and review organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Operations Section Chief with other section directors and assist

with development of the Operations Section's action plan. Designate time for followup meeting.

____ Appoint Staff Support Unit Leader, Psychological Support Unit Leader andDependent Care Unit Leader. Distribute corresponding Job Action Sheets andidentification vests.

____ Brief unit leaders on current situation; outline action plan for subsection and designatetime for next briefing.

____ Establish Human Services Center near Discharge Area or near staff rest/rehabilitationarea.

____ Assist with establishment of Discharge Area. Lend support personnel to assist withpatient discharge process.

____ Assist in the implementation of patient early discharge protocol on the direction ofOperations Section Chief. Secure the aid of Nursing Unit Leader.

Intermediate ____ Assist Psychological Support Unit Leader in securing a debriefing area.____ Meet regularly with unit leaders to receive updates and requests.____ Communicate frequently with Operations Section Chief.

Extended ____ Document action and decisions on a continual basis.____ Observe and assist anyone who exhibits signs of stress and fatigue. Provide for staff

rest and relief.____ Other concerns:

2 - 58



Staff Support Unit Leader


STAFF SUPPORT UNIT LEADER


You Report To: (Human Services Director)


Mission: Assure the provision of logistical and psychological support of the hospital staff.

Immediate ____ Receive assignment from Human Services Director.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Human Services Director with other subsection unit leaders;

assist in development of subsection action plan. Designate time for follow up meeting.____ Anticipate staff needs as they might relate to the specific disaster.

Intermediate ____ Establish a staff rest and nutritional area in a low traffic area. Provide for a calmrelaxing environment provide overall disaster information updates (bulletins) for rumorcontrol.

____ Provide for nutritional support and sleeping arrangements; contact Nutritional SupplyUnit Leader and Labor Pool Unit Leader for assistance.

____ Establish a staff Information Center with the help of Communications Unit Leader,Nursing Unit Leader and Labor Pool Unit Leader. Provide overall disaster infoupdates (bulletins) for rumor control.

____ Arrange for routine visits/evaluations by the Psychological Support Unit Leader.Assist in establishment of separate debriefing area.

Extended ____ Observe all staff closely for signs of stress and fatigue; intervene appropriately.Provide for personal staff rest periods and relief.

____ Assist staff with logistical and personal concerns; act as facilitator when appropriate.____ Report routinely to the Human Services Director.____ Document all actions, decisions and interventions.____ Other concerns:

2 - 59



Psychological Support Unit Leader


PSYCHOLOGICAL SUPPORT UNIT LEADER




Mission: Assure the provision of psychological, spiritual and emotional support to the hospital staff,patients, dependents and guests. Initiate and organize the Critical Stress Debriefing process.

Immediate ____ Receive appointment from Human Services Director.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Receive briefing from Human Services Director; assist in development of subsection

action plan. Designate time for follow up meeting.____ Establish teams composed of staff, clergy and other mental health professionals to

support the psycho-social needs of the staff, patients and guests.Intermediate ____ Designate a secluded debriefing area where individual and group intervention may take

place. Coordinate with Staff Support Unit Leader.____ Appoint psychological support staff to visit patient care and non-patient care areas on

a routine schedule.____ Meet regularly with all members of the Human Services Subsection.____ Assist the Staff Support Unit Leader in establishment of staff information/status board

(situation, disaster update, hospital activities).Extended ____ Advise psychological support staff to document all contacts.

____ Observe psychological support staff for signs of stress and fatigue. Arrange forfrequent, mandatory rest periods and debriefing sessions.

____ Schedule and post the dates and times for critical stress debriefing sessions during andafter the immediate disaster period.

____ Document all actions, decisions and interventions.____ Other concerns:

2 - 60



Dependent Care Unit Leader


DEPENDENT CARE UNIT LEADER




Mission: Initiate and direct the sheltering and feeding of staff and volunteer dependents.

Immediate ____ Receive appointment from Human Services Director.____ Read this entire Job Action Sheet and review the organizational chart on back.____ Put on position identification vest.____ Obtain briefing from Human Services Director; participate in development of

subsection action plan. Designate time for follow up meeting.____ Establish a controlled, comfortable area where patients and visitors may wait for

disposition home.Intermediate ____ Establish a Dependent Care Area removed from any patient care areas.

____ Obtain volunteers from the Labor Pool to assist with child and/or adult care. Maketentative plans for extended care.

____ Monitor the area continuously for safety and dependant needs with a minimum of twohospital employees.

____ Implement a positive I.D. system for all children cared for under age of 10 years ofage. Provide matching I.D. for retrieving guardian to show upon release of child.

____ Document care and all personnel in the area.____ Contact the Safety & Security Officer for assistance.____ Contact Materials Supply Unit Leader and Nutritional Supply Unit Leader for

supplies and food; advise Situation - Status Unit Leader and Labor Pool Unit Leaderof any extended plans.

Extended ____ Assure that those dependents taking medications have sufficient supply for estimatedlength of stay.

____ Arrange for the Psychological Support Unit Leader to make routine contact withdependents in the shelter, as well as responding when necessary.

____ Observe staff and dependents for signs of stress and fatigue. Provide for staff restperiods and relief.

____ Report routinely to Human Services Director. Document allactions/decisions.


3 - 1

SECTION 3

HOSPITAL EMERGENCYINCIDENT COMMAND

SYSTEM

FORMS

3 - 2

III. The Hospital Emergency Incident Command SystemForms

This chapter contains the various forms used with the HEICS job assignments. The forms are very simple andself-explanatory. While paper work is often portrayed as burdensome, it should also be pointed out that throughaccurate documentation an event can be reconstructed so that lessons may be learned. Sound documentation isalso the beginning step in the road to financial recovery.

The pages in this chapter have not been indexed with page numbers so that the forms may be reproduced on aphotocopy machine. The following is an indexing of the forms and those positions intended to use them:

Activity Log All officers

Section Personnel Time Sheet Each Section Chief or aide

Procurement Summary Report Procurement Unit Leader

Volunteer Staff Registration/ Labor Pool Unit LeaderCredentialing Form

Facility Systems Status Report Damage Assessment and Control Officer

Resource Accounting Record Each Section Chief or aide

Patient Tracking Sheet Patient Tracking Officer

Action Plan Incident Commander, Section Chiefs and individuals

Emergency Incident Message Forms All personnel

3 - 3

HEICS III

H E I C S

ACTIVITY LOG

Date: / / Section: ______________________________________

Position Title: Individual Name:_______________________________

# Time Incident - Problem Situation Action

1

2

3.

4

5

6

7

8

9

10

11

This form is intended for use by all individuals as an accounting of their personal action or the section activity.

Original: Immediate Supervisor or Copy: Position/Section Documentation Section Chief

3 - 4

HEICS III

H E I C SSECTION PERSONNEL TIME SHEET

Date: / / Section: ____________________________________

Hours: From: To:______________________

#(Please Print)

Employee/Volunteer Name Title/Job Class Signature Time In Time OutTotalHours

1

2

3

4

5

6

7

8

9

10

11

12

13

Certifying Officer: Date/Time:______________________________________________

Original = TIME UNIT LEADER (Finance Section) every 12 hours.

3 - 5

HEICS III

H E I C SPROCUREMENT SUMMARY REPORT

# P.O. # Date/Time Item/Service Vendor $ Amount Requestor Approval

1

2

3

4

5

6

7

8

9

10

11

12

13

Certifying Officer: Date/Time: ___________________________________

3 - 6

HEICS III

H E I C SVOLUNTEER STAFF REGISTRATION/CREDENTIALING FORM

DATE: / / Event: ______________________________________________

#(Print)Name

(Print)Address Signature

Driver'sLicense #

PROF/TECHLIC #

SpecialtySkills

EmployerAddress

TimeIN

TimeOUT

SecurityFollow-up

1

2

3

4

5

6

7

8

9

10

11

12

13

Certifying Officer: Date/Time: _____________________________________

Original: Labor Pool Unit Leader Copy: Safety/Security Officer

3 - 8

HEICS III

H E I C SFACILITY SYSTEM STATUS REPORT

Date: / / _______

Time: Certifying Officer:______________________________

System Operational Status

Comments(If Non-Operational, Give Reason AndEstimate Time/Resources ToNecessitate Repair

Structural Components

Electrical Power-Primary Service

Electrical Power Backup Generator

Water

Natural Gas

Oxygen

Other Medical Gases

Page 1 of 3

3 - 9

HEICS III



Air Compressor

Fire Prevention/Mitigation Components

Vacuum (for patient use)

Steam Boiler

Water Heater and Circulators

Heating-Air Conditioning

ETO

Pneumatic Tube

Page 2 of 3

3 - 10

HEICS III



Telephone

FAX

Radio Equipment

Paging - Public Address

Food Preparation Equipment

Laundry Service Equipment

Video-Television Cable

Non-structural Components

Other

Page 3 of 3

3 - 10

HEICS III

H E I C SRESOURCE ACCOUNTING RECORD

Date: / / Section: __________________________________G 0000 - 1159 hours G 1200 - 2359 hours

Time Item/Product Description Rece'd From Dispensed To Initials

Certifying Officer: Date/Time: ___________________________

Original: Section Chief Copy: Finance Chief

3 - 11

HEICS III

HEICS PATIENT TRACKING SHEET

DATE: / / Event: ___________________________________

L o c a t i o n

Patient # Patient Name Age Status Disposition

Certifying Officer: Date/Time: _______________________________

3 - 12

HEICS III

HEICS ACTION PLAN

Incident: Date: Section/Position:

Officer: For Time Period:

GOAL(S): OBJECTIVES for Goal Achievement:

1.

2.

3.

4.

5.

6.

Resources Needed: Obtained from/time:

1.

2.

3.

4.

5.

6.

Goals(s) Completed/Status Reported to/time :

Signature: Position: Time:

3 - 13

HEICS III

HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEMEMERGENCY INCIDENT MESSAGE FORM

______________________________________________________________________________________

FILL IN ALL INFORMATION

TO (Receiver): ____________________________________________________________

FROM (Sender): _____________________________________________________________

DATE & TIME : _____________________________________________________________

PRIORITYG Urgent-Top G Non Urgent-Moderate G Informational-Low

Message:

Received By: Time Received: Comments:

Forward To:

Received By: Time Received: Comments:

Forward To:

KEEP ALL MESSAGES REQUESTS BRIEF, TO THE POINT AN D VERY SPECIFIC.

Original: Receiver Copy #1: Communications Officer Copy #2: Sender

heics h e i c s - the breaking newsheics h e i c s the hospital emergency incident command system...

Documents